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Organization
TYSON DRUG INC
Active
Organization
TYSON DRUG INC
Active
Other names
POTTS CAMP PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LOMENICK (OWNER)
(662) 252-2321
Entity
Organization
Contact information
Practice address
41 S CENTER ST, POTTS CAMP, MS 38659-9531
(662) 333-7782
(662) 333-4095
Mailing address
41 S CENTER ST, POTTS CAMP, MS 38659-9531
(662) 333-7782
(662) 333-4095
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
02436/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330080
—
MS
01
—
2045412
PK
—
Enumeration date
06/17/2005
Last updated
02/20/2017
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