=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902841265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUTCH PHARMACIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2006
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1313 S ADAMS ST
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38843-8862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-862-7979
-----------------------------------------------------
Fax | 662-862-7843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1313 S ADAMS ST
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38843-8862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-862-7979
-----------------------------------------------------
Fax | 662-862-7843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSEPH GILLIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-327-5202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 07471/01.2
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------