1285702159 NPI number — LOGANS DISCOUNT DRUGS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285702159 NPI number — LOGANS DISCOUNT DRUGS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOGANS DISCOUNT 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:
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:
1285702159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 697
Provider Second Line Business Mailing Address:
129 SOUTH NEWBERGER
Provider Business Mailing Address City Name:
BRUCE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38915-0697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-983-7800
Provider Business Mailing Address Fax Number:
662-983-7806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 SOUTH NEWBERGER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUCE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38915-0697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-983-7800
Provider Business Practice Location Address Fax Number:
662-983-7806
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOGAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PHARMACIST OWNER
Authorized Official Telephone Number:
662-983-7800

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00440635 . This is a "MEDICAID DME #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0330263 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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