Hollis Discount Pharmacy, Inc
Organization Active NPI Pharmacy · Ripley, MS
NPI 1194889568 · NPPES record last updated Apr 16, 2023
Key facts
- NPI
- 1194889568
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- MS1326 (MS)
- Legal business name
- HOLLIS DISCOUNT PHARMACY, INC
- Practice address
- 1008 City Ave N
Ripley, MS 38663-1413 - Phone
- (662) 837-4774
- NPI assigned
- Dec 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jimmy L Tucker, RPH
- Title
- Ceo/President
- Phone
- (662) 837-7323
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231020001240 | MS | Part B Supplier - Pharmacy | 5193845493 | Practice locations: Ripley, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | MS1326 | MS | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
1008 City Ave N
Ripley, MS 38663-1413
Mailing address
1008 City Ave N
Ripley, MS 38663-1413
Phone (662) 837-4774
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00095087 | Medicaid | MS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | MELINDA@PRINCETONDRUGSTORE.COM | Direct |
Other providers in Ripley, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.