1003060047 NPI number — GREENWOOD DOWNTOWN DRUGS INC

Table of content: MS. HEATHER ALLENE BEDELL L.C.P.C. (NPI 1578607404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003060047 NPI number — GREENWOOD DOWNTOWN DRUGS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWOOD DOWNTOWN DRUGS INC
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:
6
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:
1003060047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 CARROLLTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38930-4436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-453-4401
Provider Business Mailing Address Fax Number:
662-453-2527

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 CARROLLTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38930-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-453-4401
Provider Business Practice Location Address Fax Number:
662-453-2527
Provider Enumeration Date:
11/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
GUY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND OWNER
Authorized Official Telephone Number:
662-887-4135

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: 11389/1.1 , 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: 2135379 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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