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General NPI Number Information
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NPI Number | 1790837961
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Entity Type | Organization
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Legal Business Name | COX-BLYTHE DRUG COMPANY
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 122 W COLLEGE ST
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City | BOONEVILLE
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State | MS
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Zip | 38829-3410
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Country | US
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Telephone | 662-728-5732
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Fax | 662-728-5756
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Provider Business Mailing Address
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Address Line | 122 W COLLEGE ST
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City | BOONEVILLE
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State | MS
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Zip | 38829-3410
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Country | US
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Telephone | 662-728-7332
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Fax | 662-728-5756
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Authorized Official
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Title or Position | PHARMACIST AND OWNER
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Name | JOHN DAVIS
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Credential |
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Telephone | 662-728-5732
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 00212
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License Number State | MS
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