Sumrall Drug Store LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

00461011 Issued in MS

Legal business name

SUMRALL DRUG STORE LLC

Doing business as

Sumrall Drug Store

Practice address

1109 Hwy 42
Sumrall, MS 39482-0246

Phone

(601) 758-4243

Fax

(601) 758-4999

NPI assigned

Oct 16, 2006

Last updated

Dec 7, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Beau Haden, PHARMDNPI 1497351670

Title

Owner

Phone

(601) 758-4243

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SUMRALL DRUG STORE Doing business as

Medicare fee-for-service enrollment

Enrolled in MS3 enrollments

Enrollment records 3

Tax ID family

Sumrall Drug Store2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Sumrall Drug Store LLC

  dba Sumrall Drug Store Long Term Care

  • Long Term Care Pharmacy
  • Sumrall, MS
  • NPI 1366004731
  NPD tax ID

Practitioners 4

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.

• Beau Landry Haden, PHARMD

  • Community/Retail Pharmacy
  • Sumrall, MS
  • NPI 1497351670
  NPD Authorized official
• Tasha F Haden, PHARMD

  • Pharmacist
  • Sumrall, MS
  • NPI 1629664586
  NPD
• Jennifer Beach

  • Pharmacist
  • Sumrall, MS
  • NPI 1578159109
  NPD (past)
• Brandon Scott Nesler

  • Pharmacist
  • Sumrall, MS
  • NPI 1871128934
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1275613952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "394820120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 HWY 42",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "394820246",
            "telephone_number": "601-758-4243",
            "fax_number": "601-758-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMRALL DRUG STORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "HADEN",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-758-4243",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "00461011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0092193",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2047304",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUMRALL DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Alyssa Smith, FNP-C
• South Mississippi Emergency Physicians,PA
• Southern Saferide Transportation
• Austin Laroy Stringer, PT
• Sarah Stroud, MS, RD, LD
• Sumrall Drug Store LLC (Sumrall Drug Store Long Term Care)
• Sumrall Elementary School
• Sumrall Family Health Center
• Sumrall High School
• Sumrall Middle School

• Community/Retail Pharmacy in Sumrall, MS
• Providers in Sumrall, 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 Dec 7, 2016; 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.