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Organization
POLKS CROSSGATES DISCOUNT DRUGS, INC.
Active
Organization
POLKS CROSSGATES DISCOUNT DRUGS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL SCOTT BYRD R.PH. (PHARMACIST)
(601) 825-8660
Entity
Organization
Contact information
Practice address
335 CROSSGATES BLVD, BRANDON, MS 39042-2602
(601) 825-8660
(601) 825-6983
Mailing address
335 CROSSGATES BLVD, BRANDON, MS 39042-2602
(601) 825-8660
(601) 825-6983
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
01619/01.2
MS
3336C0003X
Community/Retail Pharmacy
Primary
01619- 01.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00045115
—
MS
05
—
00095346
—
MS
Enumeration date
07/04/2006
Last updated
12/18/2012
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