MEDICARE: MISSISSIPPI DISCOUNT DRUGS OF CLINTON 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	00837/01.1	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2501561	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1730186982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI DISCOUNT DRUGS OF CLINTON INC

Provider Business Mailing Address
First Line	:	224 CLINTON BLVD
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-5126
Country	:	US
Telephone Number	:	601-924-5212
Fax Number	:	601-924-4649

Provider Business Practice Location Address
First Line	:	224 CLINTON BLVD
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-5126
Country	:	US
Telephone Number	:	601-924-5212
Fax Number	:	601-924-4649

Authorized Official
Title or Position	:	GENERAL MGR AND OWNER
Name	:	CARY PARKS
Credential	:	ACCOUNTING
Telephone Number	:	601-924-5212

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	08/02/2011

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