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Organization
ESSCO DISCOUNT DRUG CENTER INC
Active
Organization
ESSCO DISCOUNT DRUG CENTER INC
Active
Other names
ESSCO DISCOUNT DRUG CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MAX SANDERS (PRESIDENT)
(662) 746-7423
Entity
Organization
Contact information
Practice address
732 E FIFTEENTH ST, YAZOO CITY, MS 39194-2706
(662) 746-7423
(662) 746-8158
Mailing address
732 E FIFTEENTH ST, YAZOO CITY, MS 39194-2706
(662) 746-7423
(662) 746-8158
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
01409
MS
3336L0003X
Long Term Care Pharmacy
—
NULL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0030034
—
MS
01
—
2507955
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/07/2006
Last updated
08/24/2011
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