NPIMap

Organization Active NPI

Tyson Drugs Inc

  • Community/Retail Pharmacy
  • Holly Springs, MS
National Provider Identifier
1972508695
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
00500/1.1 Issued in MS
Legal business name
TYSON DRUGS INC
Practice address
145 E Van Dorn Ave
Holly Springs, MS 38635-3025
Phone
(662) 252-2321
Fax
(662) 252-1656
NPI assigned
Jun 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

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

Authorized official

Name
Robert Lomenick
Title
Owner
Phone
(662) 252-2321

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 00500/1.1 MS Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

145 E Van Dorn Ave
Holly Springs, MS 38635-3025

Mailing address

145 E Van Dorn Ave
Holly Springs, MS 38635-3025
Phone (662) 252-2321

Other identifiers 2

IdentifierTypeStateIssuer
0034797MedicaidMS
2043239OtherPK

Other names 1

  • TYSON DRUGS INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180913002588 MS Part B Supplier - Pharmacy 5991977563 2 other NPIs on this enrollment
Practice locations: Potts Camp, MS; Holly Springs, MS
O20190204000857 MS DME Supplier - Pharmacy 5991977563 Practice locations: Holly Springs, MS

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Tyson Drugs Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

530 J M Ash Dr
Holly Springs, MS 38635
Phone (662) 252-1011

Practitioners & affiliated clinicians

Practitioners 1

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": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1972508695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 E VAN DORN AVE",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386353025",
            "telephone_number": "662-252-2321",
            "fax_number": "662-252-1656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 E VAN DORN AVE",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386353025",
            "telephone_number": "662-252-2321",
            "fax_number": "662-252-1656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYSON DRUGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "LOMENICK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-252-2321"
    },
    "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": "00500/1.1",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0034797",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2043239",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TYSON DRUGS INC",
            "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 7, 2015; 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.