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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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