Polks Discount Drugs #2
Organization Active NPI Community/Retail Pharmacy · Florence, MS
NPI 1508961947 · NPPES record last updated Apr 29, 2015
Key facts
- NPI
- 1508961947
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 02014 (MS)
- Legal business name
- POLKS DISCOUNT DRUGS #2
- Practice address
- 101 49 Place
Florence, MS 39073 - Phone
- (601) 845-8610
- Fax
- (601) 845-8650
- NPI assigned
- Sep 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Kenneth Wayne Willoughby, RPH
- Title
- Pharmacist/Manager
- Phone
- (601) 845-8610
Other NPIs on the same Medicare enrollment 7
Corporate family (same tax ID) 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Polks Discount Drugs 2
Locations
101 49 Pl
Florence, MS 39073
Phone (601) 845-8610
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 02014 | MS | Yes |
Addresses
Primary practice location
101 49 Place
Florence, MS 39073
Mailing address
101 49 PL
P.O. Box 266
Florence, MS 39073-8080
Phone (601) 845-8610
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00030485 | Medicaid | MS | |
| 00040389 | Medicaid | MS |
Other names
- polks crossgates discount drugs inc
Other providers in Florence, MS
- Bret David Patterson
- Peace of Mind Counseling and Consultation, PLLC
- Emily Holder Peacock
- Amanda Perkins
- Physiotherapy Associates Inc
- Derek Wade Puckett
- Norma M Raymond
- Laurie Robinson
- Abbey Ross
- Julian Sandifer Jr.
All providers in Florence, 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 Apr 29, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.