Wallace Drug Company Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

WALLACE DRUG COMPANY INC

Doing business as

Dikets Professional Drugs

Practice address

1107 Jefferson St
Laurel, MS 39440-4352

Phone

(601) 428-4334

NPI assigned

May 3, 2022

Last updated

Jan 20, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

WALLACE DRUG COMPANY INC DBA WALLACE DISCOUNT DRUGSAs reported in NPPES

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

Authorized official

Name

Joseph M Robertson, PHARMDNPI 1841568656

Title

Owner

Phone

(601) 428-4334

Specialties & licenses 1

Addresses

Other names 1

• DIKETS PROFESSIONAL DRUGS Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Wallace Drug Company Inc

  dba Wallace Discount Drugs

  • Community/Retail Pharmacy
  • Laurel, MS
  • NPI 1396874178

  O20160910000217

  Same enrollment

Tax ID family

Wallace Drug Company Inc2 organizations share this tax ID, including this one

Part of

Wallace Drug Company Inc

Other organizations with this tax ID 1

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

• Wallace Drug Company Inc

  dba Wallace Discount Drugs

  • Community/Retail Pharmacy
  • Laurel, MS
  • NPI 1396874178
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph M Robertson, PHARM D

  • Pharmacist
  • Laurel, MS
  • NPI 1841568656
  NPD Authorized official
• Mary Blair Read, RPH

  • Pharmacist
  • Laurel, MS
  • NPI 1730998642
  NPD
• Kenneth Earl Crawford III, RPH

  • Pharmacist
  • Laurel, MS
  • NPI 1891901567
  NPD (past)

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

{
    "created_epoch": "1651536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1710622865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410446",
            "telephone_number": "601-428-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404352",
            "telephone_number": "601-428-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE DRUG COMPANY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALLACE DRUG COMPANY INC DBA WALLACE DISCOUNT DRUGS",
        "enumeration_date": "2022-05-03",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-428-4334",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIKETS PROFESSIONAL DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wal-Mart Stores, Inc. (Vision Center 30-0501)
• Walgreen Co (Walgreens #09037)
• Latoya Renee Walker, M.D.
• Jon T Wall, CRNA
• Wallace Drug Company Inc (Wallace Discount Drugs)
• Dedra Danyale Wallace
• John M. Wallace, M.D.
• Cameron Mackenzie Walley, COTA
• Tabitha Walls, CMHT
• Anna Hendry Walters, FNP-C

• Community/Retail Pharmacy in Laurel, MS
• Providers in Laurel, 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 Jan 20, 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.

Verify at the official NPI Registry.