# SULLIVAN'S DISCOUNT DRUGS INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sullivan's Discount Drugs
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154354314
- **Authorized official:** MR. DAVID CHARLES HUDSON R.PH. (PHARMACIST)
- **Authorized official phone:** (662) 289-3234

## Contact information

- **Practice address:** 109 NORTHSIDE SHOPPING CENTER, HWY 12 W, KOSCIUSKO, MS 39090
- **Practice address phone:** (662) 289-3234
- **Practice address fax:** (662) 289-3030
- **Mailing address:** 109 NORTHSIDE SHOPPING CENTER, HWY 12 W, KOSCIUSKO, MS 39090
- **Mailing address phone:** (662) 289-3234
- **Mailing address fax:** (662) 289-3030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 00233 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336L0003X | Long Term Care Pharmacy | 00233 | MS | — |

## Other

- **Enumeration date:** 07/09/2006
- **Last updated:** 08/18/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00034452 | — | MS |
| 01 | — | 2505026 | NCPDP \# | MS |