# CANOVAS CITY DRUG STORE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CITY DRUG STORE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831231851
- **Authorized official:** CHARLES CONOVA (PRESIDENT)
- **Authorized official phone:** (601) 888-3333

## Contact information

- **Practice address:** 616 MAIN ST, WOODVILLE, MS 39669-9706
- **Practice address phone:** (601) 888-3333
- **Practice address fax:** (601) 888-6336
- **Mailing address:** PO BOX 486, WOODVILLE, MS 39669-0486
- **Mailing address phone:** (601) 888-3333
- **Mailing address fax:** (601) 888-6336

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 01762/1.1 | MS | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 03/07/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00030063 | — | MS |
| 05 | — | 1250686 | — | LA |
| 01 | — | 2043600 | PK | — |