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General NPI Number Information
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NPI Number | 1760880637
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Entity Type | Organization
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Legal Business Name | TYSON DRUGS INC
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 145 E VAN DORN AVE
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City | HOLLY SPRINGS
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State | MS
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Zip | 38635-3025
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Country | US
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Telephone | 662-252-2321
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Fax | 662-252-1656
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Provider Business Mailing Address
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Address Line | 145 E VAN DORN AVE
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City | HOLLY SPRINGS
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State | MS
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Zip | 38635-3025
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Country | US
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Telephone | 662-252-2321
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Fax | 662-252-1656
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT H LOMENICK
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Credential | RPH
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Telephone | 662-252-2321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | F0500
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License Number State | MS
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