# CALVERTS DRUG STORE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CALVERTS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750409835
- **Authorized official:** THOMAS PAYNE (OWNER)
- **Authorized official phone:** (228) 257-9334

## Contact information

- **Practice address:** 2561 PASS RD, STE A, BILOXI, MS 39531-2125
- **Practice address phone:** (228) 388-1411
- **Practice address fax:** (228) 388-1484
- **Mailing address:** 2561 PASS RD, STE A, BILOXI, MS 39531-2125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 00420/01.1 | MS | Yes |

## Other

- **Enumeration date:** 03/27/2007
- **Last updated:** 05/04/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00030643 | — | MS |
| 01 | — | 2502210 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |