1598872863 NPI number — ROSE DRUG COMPANY

Table of content: (NPI 1598872863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598872863 NPI number — ROSE DRUG COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSE DRUG COMPANY
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:
1598872863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 793
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST POINT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39773-0793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-494-3341
Provider Business Mailing Address Fax Number:
662-494-3371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 COMMERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST POINT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39773-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-494-3341
Provider Business Practice Location Address Fax Number:
662-494-3371
Provider Enumeration Date:
08/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
662-494-3341

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  00848/01.1MS , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 00848/01.1 , 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: 00034045 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00045116 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".