1437261435 NPI number — DON WALDRONS MR DISCOUNT DRUGSTORE INC NO 1

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437261435 NPI number — DON WALDRONS MR DISCOUNT DRUGSTORE INC NO 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DON WALDRONS MR DISCOUNT DRUGSTORE INC NO 1
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MR DISCOUNT DRUGS #1
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437261435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39303-3790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-693-1978
Provider Business Mailing Address Fax Number:
601-693-4417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2205 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-693-1978
Provider Business Practice Location Address Fax Number:
601-693-4417
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALDRON
Authorized Official First Name:
DON
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
601-693-1978

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 01110/1.2 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00092801 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2043651 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com