Organization
OKOLONA PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY SMITH (OWNER)
(901) 831-8669
Entity
Organization
Contact information
Practice address
210 W MAIN ST, OKOLONA, MS 38860-1425
(662) 447-0300
Mailing address
210 W MAIN ST, OKOLONA, MS 38860-1425
(662) 447-0300
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00479277
—
MS
Enumeration date
08/25/2017
Last updated
05/23/2023
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