# CITY DRUG STORE OF HAZLEHURST, INC.

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

## Provider details

- **NPI number:** 1467532663
- **Authorized official:** MR. MICHAEL HENRY ROSE R. PH. (OWNER)
- **Authorized official phone:** (601) 894-1222

## Contact information

- **Practice address:** 218 CALDWELL DR, HAZLEHURST, MS 39083-2712
- **Practice address phone:** (601) 894-1222
- **Practice address fax:** (601) 894-1522
- **Mailing address:** 218 CALDWELL DR, HAZLEHURST, MS 39083-2712
- **Mailing address phone:** (601) 894-1222
- **Mailing address fax:** (601) 894-1522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | 002093 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 12/23/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00030881 | — | MS |