Ellisville Drug Acquisition Co.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

ELLISVILLE DRUG ACQUISITION CO.

Doing business as

Ellisville Drug

Practice address

915 Hill St
Ellisville, MS 39437-2419

Phone

(601) 477-3573

Fax

(601) 477-3572

NPI assigned

Oct 25, 2006

Last updated

Apr 27, 2010By 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

Mr. Deborah R Keaveny

Title

Contracting Manager

Phone

(612) 227-7811

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Ellisville Drug Doing business as

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272326400000",
    "number": "1396829438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 HIGHWAY 71 N",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719534367",
            "telephone_number": "479-394-6363",
            "fax_number": "479-394-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 HILL ST",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394372419",
            "telephone_number": "601-477-3573",
            "fax_number": "601-477-3572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLISVILLE DRUG ACQUISITION CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2010-04-27",
        "status": "A",
        "authorized_official_last_name": "KEAVENY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CONTRACTING MANAGER",
        "authorized_official_telephone_number": "612-227-7811",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MS",
            "license": "00140011",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2501218",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0330711",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellisville Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Ellisville, MS
• Providers in Ellisville, 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 Apr 27, 2010; 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.