1063472793 NPI number — BIGGS DRUGSTORE

Table of content: (NPI 1063472793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063472793 NPI number — BIGGS DRUGSTORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIGGS DRUGSTORE
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:
Provider Other Organization Name Type Code:
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:
1063472793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E GEORGETOWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39059-2777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-892-4061
Provider Business Mailing Address Fax Number:
601-892-6055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E GEORGETOWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39059-2777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-892-4061
Provider Business Practice Location Address Fax Number:
601-892-6055
Provider Enumeration Date:
03/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPELL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
601-892-4061

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 00613/01.1 , 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: 00030414 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com