Southern Discount Drugs of Charleston Inc
Organization Active NPI Durable Medical Equipment & Medical Supplies · Charleston, MS
NPI 1104800440 · NPPES record last updated Jul 11, 2019
Key facts
- NPI
- 1104800440
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- License
- 06473/11.1 (MS)
- Legal business name
- SOUTHERN DISCOUNT DRUGS OF CHARLESTON INC
- Practice address
- 1068 Factory Dr
Charleston, MS 38921-6620 - Phone
- (662) 647-6601
- Fax
- (662) 647-2411
- NPI assigned
- Nov 30, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Robert Salmon, RPH
- Title
- Pharmacist
- Phone
- (662) 647-2591
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Southern Discount Drugs of Charlest |
Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Canes and/or Crutches|Walkers|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930048500 | MS | DME Supplier - Medical Supply Company |
9931229739 | Practice locations: Charleston, MS |
National Provider Directory
Locations
1068 Factory Dr
Charleston, MS 38921
Phone (662) 647-2591
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 06473/11.1 | MS | Yes |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 1022 | AL | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 8226997-1714 | UT | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 056014 | AR | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | DME18182 | ID | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | NPC-0003778 | OR | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | MP00957 | NV | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | P013728 | AZ |
Addresses
Primary practice location
1068 Factory Dr
Charleston, MS 38921-6620
Mailing address
1068 Factory Dr
Charleston, MS 38921-6620
Phone (662) 647-6601
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 175578701 175578702 | Medicaid | TX | |
| 1757861 | Medicaid | LA | |
| 00040385 | Medicaid | MS | |
| 4057054 | Other | TN | BC TN |
| 152800716 | Medicaid | AK |
Other names
- The Diabetic Shoppe
Other providers in Charleston, MS
- Ronal Roberson
- Angela C Rounds
- Angela Bailey Rowsey
- Anne Wilson Selby
- Shana Belle Smith
- Southern Discount Drugs of Charleston Inc.
- Square Drugs, LLC
- Tallahatchie Eyecare, PLLC
- Tallahatchie General Hospital
- Tallahatchie General Hospital
All providers in Charleston, MS · Durable Medical Equipment & Medical Supplies in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.