Active NPI
Magnolia Drugs Inc
Doing business as Magnolia Drugs
- Community/Retail Pharmacy
- Myrtle, MS
National Provider Identifier
1619535515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- MAGNOLIA DRUGS INC
- Doing business as
- Magnolia Drugs
- Practice address
- 1757 Highway 178 West
Suite B
Myrtle, MS 38650 - Phone
- (662) 988-7030
- Fax
- (662) 988-7014
- NPI assigned
- Jun 5, 2019
- Last updated
- Nov 17, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Martin Crotts
- Title
- Owner
- Phone
- (662) 988-7030
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | NU | Primary |
Addresses
Primary practice location
1757 Highway 178 West
Suite B
Myrtle, MS 38650
Mailing address
1757 Highway 178 W Ste B
Myrtle, MS 38650-9233
Phone (662) 988-7030
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007726090 | Medicaid | MS |
Other names 1
- Magnolia Drugs
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200505000552 | MS | Part B Supplier - Pharmacy | 5193156271 | Practice locations: Myrtle, MS |
National Provider Directory
National Provider DirectoryLocations
1757 Highway 178 W
#B
Myrtle, MS 38650
Phone (662) 988-7030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559692800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1763337600000",
"number": "1619535515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1757 HIGHWAY 178 W STE B",
"city": "MYRTLE",
"state": "MS",
"postal_code": "386509233",
"telephone_number": "662-988-7030",
"fax_number": "662-988-7014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1757 HIGHWAY 178 WEST",
"address_2": "SUITE B",
"city": "MYRTLE",
"state": "MS",
"postal_code": "38650",
"telephone_number": "662-988-7030",
"fax_number": "662-988-7014"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAGNOLIA DRUGS INC",
"organizational_subpart": "NO",
"enumeration_date": "2019-06-05",
"last_updated": "2025-11-17",
"certification_date": "2025-11-17",
"status": "A",
"authorized_official_last_name": "CROTTS",
"authorized_official_first_name": "MARTIN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "662-988-7030"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007726090",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Magnolia Drugs",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Magnolia Drugs",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Myrtle, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; 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.