Picayune Drug Co., Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

055-05477-9 Issued in MS

Legal business name

PICAYUNE DRUG CO., INC.

Practice address

110 Highway 11 N
Picayune, MS 39466-3312

Phone

(601) 798-4846

Fax

(601) 798-4825

NPI assigned

Jun 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Andrew L Failla, R PH

Title

President

Phone

(601) 798-4846

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Picayune Drug Co., Inc.

  • Community/Retail Pharmacy
  • Picayune, MS
  • NPI 1922027622

  1456478635

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Picayune Drug Co., Inc.

  • Community/Retail Pharmacy
  • Picayune, MS
  • NPI 1922027622

  O20210412000984

  Same enrollment

Locations

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1689601957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394660010",
            "telephone_number": "601-798-4846",
            "fax_number": "601-798-4825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 HIGHWAY 11 N",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394663312",
            "telephone_number": "601-798-4846",
            "fax_number": "601-798-4825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PICAYUNE DRUG CO., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2021-04-12",
        "certification_date": "2021-03-24",
        "status": "A",
        "authorized_official_last_name": "FAILLA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-798-4846",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "055-05477-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00045164",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Picayune Clinic LLC
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• Picayune Eye Clinic
• Picayune Family Health Center
• Picayune Family Practice Clinic, LLC
• Picayune General Dentistry, Inc.

• All providers in Picayune, MS
• Durable Medical Equipment & Medical Supplies in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; 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.