NPIMap

Organization Active NPI

Yalobusha General Hospital

Doing business as The Drug Store

  • Community/Retail Pharmacy
  • Coffeeville, MS
National Provider Identifier
1154465912
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
01605011 Issued in MS
Legal business name
YALOBUSHA GENERAL HOSPITAL
Doing business as
The Drug Store
Practice address
31 Front St
Coffeeville, MS 38922-3352
Phone
(662) 675-2775
Fax
(662) 675-8477
NPI assigned
Feb 16, 2007
Last updated
Dec 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Authorized official

Name
Jessica Embry, CEO
Title
Authorized Official
Phone
(662) 675-2775

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 01605011 MS Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

31 Front St
Coffeeville, MS 38922-3352

Mailing address

31 Front St
Coffeeville, MS 38922-3352
Phone (662) 675-2775

Other identifiers 2

IdentifierTypeStateIssuer
2050691OtherPK
00093220MedicaidMS

Other names 1

  • THE DRUG STORE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Yalobusha County Nursing Home Dba Yalobusha General Hospital16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

31 Front St
Coffeeville, MS 38922
Phone (662) 675-2775

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1154465912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 FRONT ST",
            "city": "COFFEEVILLE",
            "state": "MS",
            "postal_code": "389223352",
            "telephone_number": "662-675-2775",
            "fax_number": "662-675-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 FRONT ST",
            "city": "COFFEEVILLE",
            "state": "MS",
            "postal_code": "389223352",
            "telephone_number": "662-675-2775",
            "fax_number": "662-675-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YALOBUSHA GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "EMBRY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "662-675-2775",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "01605011",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2050691",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00093220",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coffeeville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.