Organization
POLKS CROSSGATES DISCOUNT DRUGS INC 6
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRIS WAYNE BENTON PHARM D (PHARMACY MANAGER)
(601) 371-8662
Entity
Organization
Contact information
Practice address
7264 SIWELL ROAD, BYRAM, MS 39272
(601) 371-8662
(601) 371-8671
Mailing address
7264 SIWELL ROAD, BYRAM, MS 39272
(601) 371-8662
(601) 371-8671
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
03328
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330223
—
MS
Enumeration date
08/08/2006
Last updated
05/05/2015
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