# PICKLE'S DRUG STORE, INC

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

## Provider details

- **NPI number:** 1548285505
- **Authorized official:** MR. ROBERT W PICKLE JR. RPH (PRESIDENT)
- **Authorized official phone:** (662) 289-1112

## Contact information

- **Practice address:** 100 N JACKSON ST, KOSCIUSKO, MS 39090-3730
- **Practice address phone:** (662) 289-1112
- **Practice address fax:** (662) 289-5061
- **Mailing address:** 100 N JACKSON ST, KOSCIUSKO, MS 39090-3730
- **Mailing address phone:** (662) 289-1112
- **Mailing address fax:** (662) 289-5061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 00214/01.1 | MS | Yes |

## Other

- **Enumeration date:** 07/12/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330210 | — | MS |
| 05 | — | 05377705 | — | MS |
| 01 | — | 2505014 | NCPDP | MS |