Organization
YALOBUSHA GENERAL HOSPITAL
Active
Other names
THE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA EMBRY CEO (AUTHORIZED OFFICIAL)
(662) 675-2775
Entity
Organization
Contact information
Practice address
31 FRONT ST, COFFEEVILLE, MS 38922-3352
(662) 675-2775
(662) 675-8477
Mailing address
31 FRONT ST, COFFEEVILLE, MS 38922-3352
(662) 675-2775
(662) 675-8477
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
01605011
MS
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00093220
—
MS
01
—
2050691
PK
—
Enumeration date
02/16/2007
Last updated
12/17/2021
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