Tyson Drug Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

02436/01.1 Issued in MS

Legal business name

TYSON DRUG INC

Doing business as

Potts Camp Pharmacy

Practice address

41 S Center St
Potts Camp, MS 38659-9531

Phone

(662) 333-7782

Fax

(662) 333-4095

NPI assigned

Jun 17, 2005

Last updated

Feb 20, 2017By 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

Robert Lomenick

Title

Owner

Phone

(662) 252-2321

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• POTTS CAMP PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Tyson Drugs Inc

  dba Tysons Medical Center Pharmacy

  • Pharmacy
  • Holly Springs, MS
  • NPI 1932104650

  O20180913002588

  Same enrollment
• Tyson Drugs Inc

  • Community/Retail Pharmacy
  • Holly Springs, MS
  • NPI 1972508695

  O20180913002588

  Same enrollment

Tax ID family

Tyson Drugs Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Tyson Drugs Inc

  dba Tyson Drugs Inc LTC

  • Long Term Care Pharmacy
  • Holly Springs, MS
  • NPI 1194441493
  NPD tax ID
• Tyson Drugs Inc

  • Long Term Care Pharmacy
  • Holly Springs, MS
  • NPI 1760880637
  NPD tax ID
• Tyson Drugs Inc

  • Community/Retail Pharmacy
  • Holly Springs, MS
  • NPI 1972508695
  NPD tax ID

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.

• Laura Jo Gardner, PHARM.D.

  • Pharmacist
  • Potts Camp, MS
  • NPI 1801192257
  NPD (past)

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1285639906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 S CENTER ST",
            "city": "POTTS CAMP",
            "state": "MS",
            "postal_code": "386599531",
            "telephone_number": "662-333-7782",
            "fax_number": "662-333-4095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 S CENTER ST",
            "city": "POTTS CAMP",
            "state": "MS",
            "postal_code": "386599531",
            "telephone_number": "662-333-7782",
            "fax_number": "662-333-4095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYSON DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "LOMENICK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-252-2321"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "02436/01.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330080",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2045412",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POTTS CAMP PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morgan Elizabeth Coe, CPHT
• Ali Crawford, MSN, APRN, FNP-C
• Laura Jo Gardner, PHARM.D.
• Jennifer Leigh McMinn, FNP
• Potts Camp Family Medical Clinic

• Community/Retail Pharmacy in Potts Camp, MS
• Providers in Potts Camp, 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 Feb 20, 2017; 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.