Sullivan'S Discount Drugs Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SULLIVAN'S DISCOUNT DRUGS INC.

Doing business as

Sullivan's Discount Drugs

Practice address

109 Northside Shopping Center
Hwy 12 W
Kosciusko, MS 39090

Phone

(662) 289-3234

Fax

(662) 289-3030

NPI assigned

Jul 9, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Charles Hudson, R.PH.NPI 1083648364

Title

Pharmacist

Phone

(662) 289-3234

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Sullivan's Discount Drugs Doing business as

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Charles Hudson, R.PH.

  • Pharmacist
  • Kosciusko, MS
  • NPI 1083648364
  NPD (past) Authorized official
• Jennifer J Warrington, PHARMD

  • Pharmacist
  • Kosciusko, MS
  • NPI 1316468184
  NPD
• Caroline Boydstun Fair, PHARMD

  • Pharmacist
  • Kosciusko, MS
  • NPI 1508371675
  NPD (past)
• Carley J Puckett, PHARMD

  • Pharmacist
  • Kosciusko, MS
  • NPI 1295624872
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1154354314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 NORTHSIDE SHOPPING CENTER",
            "address_2": "HWY 12 W",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "39090",
            "telephone_number": "662-289-3234",
            "fax_number": "662-289-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 NORTHSIDE SHOPPING CENTER",
            "address_2": "HWY 12 W",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "39090",
            "telephone_number": "662-289-3234",
            "fax_number": "662-289-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN'S DISCOUNT DRUGS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "662-289-3234",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MS",
            "license": "00233",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MS",
            "license": "00233",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00034452",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "2505026",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan's Discount Drugs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sullivan's Discount Drugs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Don E. Smith Sr., DDS
• Don Edwin Smith Jr., D.M.D.
• Timothy M. South, FNP
• Southern Pharmaceutical Corporation
• Tanya L Steen, O.T.
• Sullivan'S Discount Drugs, Inc
• Susan Cappelli PT LLC
• Karla Barrentine Tate, M.S. CCC-SLP
• Angela M Thomas, OD
• Hollie Thomas

• Community/Retail Pharmacy in Kosciusko, MS
• Providers in Kosciusko, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.