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General NPI Number Information
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NPI Number | 1699817361
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DISCOUN T DRUGS
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 1220 LASALLE ST
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City | MCCOMB
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State | MS
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Zip | 39648-5158
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Country | US
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Telephone | 601-684-4541
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Fax | 601-684-4003
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Provider Business Mailing Address
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Address Line | 1220 LASALLE ST
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City | MCCOMB
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State | MS
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Zip | 39648-5158
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Country | US
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Telephone | 601-684-4541
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Fax | 601-684-4003
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOE KEITH GUY
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Credential | RPH
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Telephone | 601-684-4541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 01536101
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License Number State | MS
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