# POLKS CROSSGATES DISCOUNT DRUGS, INC.

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

## Provider details

- **NPI number:** 1629008859
- **Authorized official:** MR. MICHAEL SCOTT BYRD R.PH. (PHARMACIST)
- **Authorized official phone:** (601) 825-8660

## Contact information

- **Practice address:** 335 CROSSGATES BLVD, BRANDON, MS 39042-2602
- **Practice address phone:** (601) 825-8660
- **Practice address fax:** (601) 825-6983
- **Mailing address:** 335 CROSSGATES BLVD, BRANDON, MS 39042-2602
- **Mailing address phone:** (601) 825-8660
- **Mailing address fax:** (601) 825-6983

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 01619/01.2 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | 01619- 01.2 | MS | Yes |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 12/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00045115 | — | MS |
| 05 | — | 00095346 | — | MS |