NPIMap

Organization Active NPI

Canovas City Drug Store

Doing business as City Drug Store

  • Community/Retail Pharmacy
  • Woodville, MS
National Provider Identifier
1831231851
Registry record updated Mar 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
01762/1.1 Issued in MS
Legal business name
CANOVAS CITY DRUG STORE
Doing business as
City Drug Store
Practice address
616 Main St
Woodville, MS 39669-9706
Phone
(601) 888-3333
Fax
(601) 888-6336
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2016

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

Authorized official

Name
Charles Conova
Title
President
Phone
(601) 888-3333

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 01762/1.1 MS Primary

Addresses

Primary practice location

616 Main St
Woodville, MS 39669-9706

Mailing address

PO Box 486
Woodville, MS 39669-0486
Phone (601) 888-3333

Other identifiers 3

IdentifierTypeStateIssuer
2043600OtherPK
1250686MedicaidLA
00030063MedicaidMS

Other names 1

  • CITY DRUG STORE Doing business as

National Provider Directory

National Provider Directory

Locations

616 Main St
Woodville, MS 39669
Phone (601) 888-3333

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457308800000",
    "number": "1831231851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 486",
            "city": "WOODVILLE",
            "state": "MS",
            "postal_code": "396690486",
            "telephone_number": "601-888-3333",
            "fax_number": "601-888-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 MAIN ST",
            "city": "WOODVILLE",
            "state": "MS",
            "postal_code": "396699706",
            "telephone_number": "601-888-3333",
            "fax_number": "601-888-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANOVAS CITY DRUG STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2016-03-07",
        "status": "A",
        "authorized_official_last_name": "CONOVA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-888-3333"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "01762/1.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2043600",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1250686",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00030063",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CITY DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; 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.