# TYSON DRUG INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** POTTS CAMP PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285639906
- **Authorized official:** ROBERT LOMENICK (OWNER)
- **Authorized official phone:** (662) 252-2321

## Contact information

- **Practice address:** 41 S CENTER ST, POTTS CAMP, MS 38659-9531
- **Practice address phone:** (662) 333-7782
- **Practice address fax:** (662) 333-4095
- **Mailing address:** 41 S CENTER ST, POTTS CAMP, MS 38659-9531
- **Mailing address phone:** (662) 333-7782
- **Mailing address fax:** (662) 333-4095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 02436/01.1 | MS | Yes |

## Other

- **Enumeration date:** 06/17/2005
- **Last updated:** 02/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330080 | — | MS |
| 01 | — | 2045412 | PK | — |