# OKOLONA PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Okolona Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629455431
- **Authorized official:** TONY SMITH (OWNER)
- **Authorized official phone:** (901) 831-8669

## Contact information

- **Practice address:** 210 W MAIN ST, OKOLONA, MS 38860-1425
- **Practice address phone:** (662) 447-0300
- **Practice address fax:** (662) 447-0130
- **Mailing address:** 210 W MAIN ST, OKOLONA, MS 38860-1425
- **Mailing address phone:** (662) 447-0300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 14335/1.1 | MS | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 04/30/2015
- **Last updated:** 05/23/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00479277 | — | MS |
| 01 | — | 2151821 | PK | — |