NPIMap

Organization Active NPI

Polk'S Crossgate Discount Drugs Inc.

  • Community/Retail Pharmacy
  • Brandon, MS
National Provider Identifier
1306097902
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
07891/01.2 Issued in MS
Legal business name
POLK'S CROSSGATE DISCOUNT DRUGS INC.
Practice address
1031 Star Rd
Brandon, MS 39042-9010
Phone
(601) 825-4507
Fax
(601) 825-4524
NPI assigned
Oct 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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

Authorized official

Name
Dennis Smith
Title
Manager
Phone
(601) 940-0668

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 07891/01.2 MS Primary

Addresses

Primary practice location

1031 Star Rd
Brandon, MS 39042-9010

Mailing address

1031 Star Rd
Brandon, MS 39042-9010
Phone (601) 825-4507

Other identifiers 2

IdentifierTypeStateIssuer
07308025MedicaidMS
2117242OtherPK

Other names 1

  • Polk's Discount Drugs #7 Doing business as

Other NPIs on the same Medicare enrollment 7

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

Practitioners 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2182729Polk'S Drugs #71031 Star Rd, Brandon, MS 39042Certificate of waiverApr 23, 2028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080604000168 MS Part B Supplier - Mass Immunization (Roster Biller Only) 2668542549 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Biloxi, MS; Richland, MS; Ocean Springs, MS; Florence, MS; Byram, MS; Brandon, MS

National Provider Directory

National Provider Directory
Tax ID family
Polks Discount Drugs 210 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1031 Star Rd
Brandon, MS 39042
Phone (601) 825-4507

NPI Registry JSON

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

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1306097902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 STAR RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390429010",
            "telephone_number": "601-825-4507",
            "fax_number": "601-825-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 STAR RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390429010",
            "telephone_number": "601-825-4507",
            "fax_number": "601-825-4524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK'S CROSSGATE DISCOUNT DRUGS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-02",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "601-940-0668"
    },
    "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": "07891/01.2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07308025",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117242",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polk's Discount Drugs #7",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brandon, MS

Sources for this page

  • 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.