# WALLACE DRUG COMPANY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WALLACE DISCOUNT DRUGS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396874178
- **Authorized official:** JOSEPH ROBERTSON (OWNER/PIC)
- **Authorized official phone:** (601) 428-1277

## Contact information

- **Practice address:** 520 N MAGNOLIA ST, LAUREL, MS 39440-3559
- **Practice address phone:** (601) 428-1277
- **Practice address fax:** (601) 428-1898
- **Mailing address:** 520 N MAGNOLIA ST, LAUREL, MS 39440-3559
- **Mailing address phone:** (601) 428-4334
- **Mailing address fax:** (601) 428-1898

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 0162611 | MS | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 01/20/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2050522 | PK | — |
| 05 | — | 34908 | — | MS |