MEDICARE: CITY DRUG STORE,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
1	183500000X	Pharmacist	00115/01.1	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2504290	OTHER	MS	NABP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558455907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY DRUG STORE,INC

Provider Business Mailing Address
First Line	:	P. O. BOX 426
Second Line	:
City	:	HOLLANDALE
State	:	MS
Zip	:	38748-0426
Country	:	US
Telephone Number	:
Fax Number	:	662-827-5561

Provider Business Practice Location Address
First Line	:	100 W. WASHINGTON ST
Second Line	:
City	:	HOLLANDALE
State	:	MS
Zip	:	38748-0426
Country	:	US
Telephone Number	:	662-827-5561
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. THOMAS HASSETT
Credential	:
Telephone Number	:	662-827-5561

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/19/2023

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Directions to “CITY DRUG STORE,INC ” Practice Location

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