Organization
SUMRALL DRUG STORE LLC
Active
Other names
SUMRALL DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
BEAU HADEN PHARMD (OWNER)
(601) 758-4243
Entity
Organization
Contact information
Practice address
1109 HWY 42, SUMRALL, MS 39482-0246
(601) 758-4243
(601) 758-4999
Mailing address
PO BOX 120, SUMRALL, MS 39482-0120
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00461011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0092193
—
MS
01
—
2047304
PK
—
Enumeration date
10/16/2006
Last updated
12/07/2016
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