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NPI Code Detail

MEDICARE: POLK'S CROSSGATE DISCOUNT DRUGS INC.

MEDICARE: POLK'S CROSSGATE DISCOUNT DRUGS 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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyF02384MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22045389OTHERPK

General Provider Information

NPI Number : 1518997410
Entity Type Code : Organization
Provider Name (Legal Business Name) : POLK'S CROSSGATE DISCOUNT DRUGS INC.
Provider Business Mailing Address
First Line : PO BOX 180038
Second Line :
City : RICHLAND
State : MS
Zip : 39218-0038
Country : US
Telephone Number : 601-932-8609
Fax Number : 601-933-0024
Provider Business Practice Location Address
First Line : 1201 HIGHWAY 49 S
Second Line : STE 2
City : RICHLAND
State : MS
Zip : 39218-9425
Country : US
Telephone Number : 601-932-8609
Fax Number : 601-933-0024
Authorized Official
Title or Position : MANAGER
Name : RONALD SKELTON
Credential : B.S. PHARMACY
Telephone Number : 601-932-8609
Provider Enumeration Date : 07/04/2006
Last Update Date : 03/13/2017

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Directions to “POLK'S CROSSGATE DISCOUNT DRUGS INC. ” Practice Location

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