=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952049454
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEARSONS DISCOUNT DRUGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2022
-----------------------------------------------------
Last Update Date | 05/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E WASHINGTON ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38851-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-456-2551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 509
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38851-0509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-456-2551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WALTER STEPHEN PEARSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-456-2551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------