Sullivan'S Drug Store,Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

00481/01.1 Issued in MS

Legal business name

SULLIVAN'S DRUG STORE,INC

Practice address

107 Van Voris St
Batesville, MS 38606-2198

Phone

(662) 563-7687

Fax

(662) 563-0260

NPI assigned

Nov 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Randell Glenn Sullivan, R.PH.

Title

Owner

Phone

(662) 563-7687

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700965811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 VAN VORIS ST",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "386062198",
            "telephone_number": "662-563-7687",
            "fax_number": "662-563-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 VAN VORIS ST",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "386062198",
            "telephone_number": "662-563-7687",
            "fax_number": "662-563-0260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN'S DRUG STORE,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "RANDELL",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-563-7687",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "00481/01.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00034444",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Strategic Solutions-Panola Medical Center LLC
• Strategic Solutions-Panola Medical Center LLC
• Shaniqua Strong, RN
• Samuel Clifton Sullivan, DMD
• Stephen E. Sullivan III, D.D.S
• Jennifer J Sullivant, R.PH.
• Sunrise Medical Group PLLC
• Superior MRI Services, Inc.
• Surrender Therapy LLC
• Sweetjam Legacy LLC

• Community/Retail Pharmacy in Batesville, MS
• Providers in Batesville, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.