Macon City Drug Store, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

06158 Issued in MS

Legal business name

MACON CITY DRUG STORE, INC.

Practice address

1556 N Oliver St
Brooksville, MS 39739-4003

Phone

(662) 738-5041

Fax

(662) 738-5043

NPI assigned

Feb 13, 2007

Organization subpart

Yes

Parent organization

MACON CITY DRUG STORE, INC.As reported in NPPES

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

Authorized official

Name

Mr. William J Bell Jr.

Title

Owner

Phone

(662) 738-5041

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brooksville Drug Store Doing business as

Tax ID family

Macon City Drug Store Inc2 organizations share this tax ID, including this one

Part of

Macon City Drug Store Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Macon City Drug Store, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Macon, MS
  • NPI 1912104415
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Macon City Drug Store, Inc.

  • Community/Retail Pharmacy
  • Macon, MS
  • NPI 1346273588
  NPPES parent name

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1639211121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 312",
            "city": "BROOKSVILLE",
            "state": "MS",
            "postal_code": "397390312",
            "telephone_number": "662-738-5041",
            "fax_number": "662-738-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1556 N OLIVER ST",
            "city": "BROOKSVILLE",
            "state": "MS",
            "postal_code": "397394003",
            "telephone_number": "662-738-5041",
            "fax_number": "662-738-5043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACON CITY DRUG STORE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MACON CITY DRUG STORE, INC.",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-738-5041",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "06158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06689871",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brooksville Drug Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brooksville Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Karla Jernigan, FNP
• Rachel Marie Lafferty, PT
• John C Mason, PHARM/D
• Charles Larry McCullouch Jr., MD
• Noxubee General Critical Access Hospital
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• Holly C Rigdon, NP

• Community/Retail Pharmacy in Brooksville, MS
• Providers in Brooksville, 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 May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.