Wallace Drug Company Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0162611 Issued in MS

Legal business name

WALLACE DRUG COMPANY INC

Doing business as

Wallace Discount Drugs

Practice address

520 N Magnolia St
Laurel, MS 39440-3559

Phone

(601) 428-1277

Fax

(601) 428-1898

NPI assigned

Mar 5, 2007

Organization subpart

No

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

Authorized official

Name

Joseph RobertsonNPI 1841568656

Title

Owner/Pic

Phone

(601) 428-1277

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• WALLACE DISCOUNT DRUGS Doing business as

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

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

• Wallace Drug Company Inc

  dba Dikets Professional Drugs

  • Community/Retail Pharmacy
  • Laurel, MS
  • NPI 1710622865

  O20160910000217

  Same enrollment

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

Medicare medical equipment & supply locations

Tax ID family

Wallace Drug Company Inc2 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.

• Wallace Drug Company Inc

  dba Dikets Professional Drugs

  • Community/Retail Pharmacy
  • Laurel, MS
  • NPI 1710622865
  NPD tax ID

Locations

Practitioners 1

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

• Joseph M Robertson, PHARM D

  • Pharmacist
  • Laurel, MS
  • NPI 1841568656
  NPD Authorized official

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1396874178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N MAGNOLIA ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394403559",
            "telephone_number": "601-428-4334",
            "fax_number": "601-428-1898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N MAGNOLIA ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394403559",
            "telephone_number": "601-428-1277",
            "fax_number": "601-428-1898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE DRUG COMPANY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "601-428-1277"
    },
    "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": "0162611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2050522",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34908",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALLACE DISCOUNT DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wal-Mart Stores East LP (Walmart Pharmacy 10-0501)
• Wal-Mart Stores, Inc. (Vision Center 30-0501)
• Walgreen Co (Walgreens #09037)
• Latoya Renee Walker, M.D.
• Jon T Wall, CRNA
• Wallace Drug Company Inc (Dikets Professional Drugs)
• Dedra Danyale Wallace
• John M. Wallace, M.D.
• Cameron Mackenzie Walley, COTA
• Tabitha Walls, CMHT

• Community/Retail Pharmacy in Laurel, MS
• Providers in Laurel, 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 Jan 20, 2025; 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.