1043421464 NPI number — K'S DISCOUNT DRUGS

Table of content: (NPI 1043421464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043421464 NPI number — K'S DISCOUNT DRUGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K'S 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:
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:
1043421464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 CIRCLE J DRIVE
Provider Second Line Business Mailing Address:
SUITE #2
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-425-0450
Provider Business Mailing Address Fax Number:
601-425-2532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 CIRCLE J DRIVE
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-425-0450
Provider Business Practice Location Address Fax Number:
601-425-2532
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KAYE
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PHARMACIST -OWNER
Authorized Official Telephone Number:
601-425-0450

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07333 01.0 . This is a "PERMIT NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 01750242 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS-07333 01.0 . This is a "CONTROLLED SUBSTANCE REG" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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