Pickle'S Drug Store, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

00214/01.1 Issued in MS

Legal business name

PICKLE'S DRUG STORE, INC

Practice address

100 N Jackson St
Kosciusko, MS 39090-3730

Phone

(662) 289-1112

Fax

(662) 289-5061

NPI assigned

Jul 12, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Robert W Pickle Jr., RPHNPI 1881616175

Title

President

Phone

(662) 289-1112

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

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

• Robert W Pickle Jr., RPH

  • Pharmacist
  • Kosciusko, MS
  • NPI 1881616175
  NPD Authorized official

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1548285505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N JACKSON ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903730",
            "telephone_number": "662-289-1112",
            "fax_number": "662-289-5061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N JACKSON ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903730",
            "telephone_number": "662-289-1112",
            "fax_number": "662-289-5061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PICKLE'S DRUG STORE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PICKLE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-289-1112",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "00214/01.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05377705",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2505014",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330210",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Bryant Pee, LPC-S
• Whitney Moore Pettit, SPEECH THERAPIST
• Olivia Phillips
• Linda A Pickering, WHNP
• Robert W Pickle Jr., RPH
• Premier Medical Group of Mississippi LLC (Kosciusko Medical Clinic)
• Annatrice Pringle
• Pro Health Aquisition Company (Cornerstone Rehabilitation of Kosciusko)
• Carley J Puckett, PHARMD
• Sarah Putt, OT

• Community/Retail Pharmacy in Kosciusko, MS
• Providers in Kosciusko, 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.