# POLKS CROSSGATES DISCOUNT DRUGS INC 6

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255341079
- **Authorized official:** DR. CHRIS WAYNE BENTON PHARM D (PHARMACY MANAGER)
- **Authorized official phone:** (601) 371-8662

## Contact information

- **Practice address:** 7264 SIWELL ROAD, BYRAM, MS 39272
- **Practice address phone:** (601) 371-8662
- **Practice address fax:** (601) 371-8671
- **Mailing address:** 7264 SIWELL ROAD, BYRAM, MS 39272
- **Mailing address phone:** (601) 371-8662
- **Mailing address fax:** (601) 371-8671

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 03328 | MS | Yes |

## Other

- **Enumeration date:** 08/08/2006
- **Last updated:** 05/05/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330223 | — | MS |