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Organization
CLAYTON DRUG STORE, INC.
Active
Organization
CLAYTON DRUG STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICK A CHAMBERS PHARM.D. (PRESIDENT)
(901) 481-1511
Entity
Organization
Contact information
Practice address
216 MAIN ST, COLLINS, MS 39428
(601) 765-4323
(601) 765-4962
Mailing address
PO BOX 787, COLLINS, MS 39428-0787
(601) 765-4323
(601) 765-4962
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00553/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030996
—
MS
01
—
00040348
MEDICAID DME
MS
01
—
2501648
NCPDP
MS
Enumeration date
08/01/2006
Last updated
10/28/2017
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