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	3336C0003X	Community/Retail Pharmacy	00837	MS

General Provider Information

NPI Number	:	1801810288
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	:

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	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BOB K PARKS
Credential	:	RPH
Telephone Number	:	601-924-5212

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	08/22/2020

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