1528333689 NPI number — MARION DISCOUNT DRUGS

Table of content: (NPI 1528333689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528333689 NPI number — MARION DISCOUNT DRUGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION DISCOUNT DRUGS
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:
MARION DISCOUNT DRUGS LLC
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:
1528333689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5332 DALE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-485-2700
Provider Business Mailing Address Fax Number:
601-485-2822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5332 DALE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-485-2700
Provider Business Practice Location Address Fax Number:
601-485-2822
Provider Enumeration Date:
03/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TINGLE
Authorized Official First Name:
MARCY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
601-485-2700

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  E-08658 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 10563/1.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 05676721 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2588703 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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