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NPI Code Detail

MEDICARE: CITY DRUGS OF CRYSTAL SPRINGS, INC.

MEDICARE: CITY DRUGS OF CRYSTAL SPRINGS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy01756/1.1MS
23336C0003XCommunity/Retail Pharmacy01756/01.1MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22501624OTHERMSNCPDP NUMBER

General Provider Information

NPI Number : 1205802980
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY DRUGS OF CRYSTAL SPRINGS, INC.
Provider Business Mailing Address
First Line : 113 BO BO DR
Second Line :
City : CRYSTAL SPRINGS
State : MS
Zip : 39059-2741
Country : US
Telephone Number : 601-892-4121
Fax Number : 601-892-1598
Provider Business Practice Location Address
First Line : 113 BO BO DR
Second Line :
City : CRYSTAL SPRINGS
State : MS
Zip : 39059-2741
Country : US
Telephone Number : 601-892-4121
Fax Number : 601-892-1598
Authorized Official
Title or Position : PHARMACIST
Name : MR. REAGAN L BROWN
Credential : RPH
Telephone Number : 601-892-4121
Provider Enumeration Date : 02/23/2006
Last Update Date : 08/10/2016

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