City Drug Store of Hazlehurst, Inc.
Organization Active NPI Community/Retail Pharmacy · Hazlehurst, MS
NPI 1467532663 · NPPES record last updated Dec 23, 2020
Key facts
- NPI
- 1467532663
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- CITY DRUG STORE OF HAZLEHURST, INC.
- Practice address
- 218 Caldwell Dr
Hazlehurst, MS 39083-2712 - Phone
- (601) 894-1222
- Fax
- (601) 894-1522
- NPI assigned
- Oct 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Henry Rose, R. PH.
- Title
- Owner
- Phone
- (601) 894-1222
Practitioners 5
-
Michael Henry Rose, RPH
-
Troy Donald Douglas, R.PH.
-
Andrea Johns, PT
-
Vicki B. Johns, R.PH.
-
Kathleen Mary Rose, R.PH.
National Provider Directory
Locations
218 Caldwell Dr
Hazlehurst, MS 39083
Phone (601) 894-1222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | 002093 | MS | |
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
218 Caldwell Dr
Hazlehurst, MS 39083-2712
Mailing address
218 Caldwell Dr
Hazlehurst, MS 39083-2712
Phone (601) 894-1222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00030881 | Medicaid | MS |
Other names
- Rose's Super Discount Drugs
Other providers in Hazlehurst, MS
- Tasha Carroll
- Lori Martin Case
- Central Mississippi Civic Improvement Association
- Central Mississippi Civic Improvement Association, Inc
- City Drug 2, LLC
- Compassionate Care Hospice LLC
- Compassionate Cares
- Compassionate Cares Home Health and Hospice
- Concerncare Pharmacy
- Olexous L Cooper
All providers in Hazlehurst, MS · Community/Retail Pharmacy in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.