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NPI Code Detail

MEDICARE: CITY DRUG, LLC

MEDICARE: CITY DRUG, LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336L0003XLong Term Care Pharmacy
43336C0003XCommunity/Retail Pharmacy

Other Identifiers

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

General Provider Information

NPI Number : 1225504269
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY DRUG, LLC
Provider Business Mailing Address
First Line : PO BOX 193
Second Line :
City : CRYSTAL SPRINGS
State : MS
Zip : 39059-0193
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 : MEMBER
Name : REAGAN LINDSAY BROWN
Credential : RPH
Telephone Number : 601-892-4121
Provider Enumeration Date : 10/17/2018
Last Update Date : 02/27/2019

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Directions to “CITY DRUG, LLC ” Practice Location

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