Active NPI
Tyson Drugs Inc
Doing business as Tysons Medical Center Pharmacy
- Pharmacy
- Holly Springs, MS
National Provider Identifier
1932104650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 0432/01.1
- Legal business name
- TYSON DRUGS INC
- Doing business as
- Tysons Medical Center Pharmacy
- Practice address
- 530 J M Ash Dr
Holly Springs, MS 38635-3238 - Phone
- (662) 252-1011
- Fax
- (662) 252-1189
- NPI assigned
- Jun 17, 2005
- Last updated
- Jan 20, 2012
- Organization subpart
- Yes
- Parent organization
- TYSON DRUGS INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Robert Hudson Lomenick, RPH
- Title
- Owner/ Pharmacist
- Phone
- (662) 252-1011
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 0432/01.1 | MS | Primary |
| Community/Retail Pharmacy | 3336C0003X | F04232 | MS |
Addresses
Primary practice location
530 J M Ash Dr
Holly Springs, MS 38635-3238
Mailing address
530 J M Ash Dr
Holly Springs, MS 38635-3238
Phone (662) 252-1011
Other names 1
- Tysons Medical Center Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180913002588 | MS | Part B Supplier - Pharmacy | 5991977563 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Potts Camp, MS; Holly Springs, MS |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Potts Camp Pharmacy
- Community/Retail Pharmacy
- Potts Camp, MS
- NPI 1285639906
O20180913002588
National Provider Directory
National Provider Directory- Part of
- Tyson Drug Inc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1327017600000",
"number": "1932104650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 J M ASH DR",
"city": "HOLLY SPRINGS",
"state": "MS",
"postal_code": "386353238",
"telephone_number": "662-252-1011",
"fax_number": "662-252-1189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 J M ASH DR",
"city": "HOLLY SPRINGS",
"state": "MS",
"postal_code": "386353238",
"telephone_number": "662-252-1011",
"fax_number": "662-252-1189"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TYSON DRUGS INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TYSON DRUGS INC",
"enumeration_date": "2005-06-17",
"last_updated": "2012-01-20",
"status": "A",
"authorized_official_last_name": "LOMENICK",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "HUDSON",
"authorized_official_title_or_position": "OWNER/ PHARMACIST",
"authorized_official_telephone_number": "662-252-1011",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MS",
"license": "0432/01.1",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MS",
"license": "F04232",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Tysons Medical Center Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Holly Springs, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; 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.