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General NPI Number Information
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NPI Number | 1750409835
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Entity Type | Organization
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Legal Business Name | CALVERTS DRUG STORE LLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 2561 PASS RD STE A
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City | BILOXI
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State | MS
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Zip | 39531-2125
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Country | US
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Telephone | 228-388-1411
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Fax | 228-388-1484
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Provider Business Mailing Address
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Address Line | 2561 PASS RD STE A
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City | BILOXI
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State | MS
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Zip | 39531-2125
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS PAYNE
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Credential |
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Telephone | 228-257-9334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 00420/01.1
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License Number State | MS
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