Organization
BACK BAY DRUGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM T AYCOCK R.PH. (PHARMACIST)
(228) 396-2257
Entity
Organization
Contact information
Practice address
10437 LAMEY BRIDGE RD, SUITE A, DIBERVILLE, MS 39540-2709
(228) 396-2228
(228) 396-2257
Mailing address
10437 LAMEY BRIDGE RD, SUITE A, DIBERVILLE, MS 39540-2709
(228) 396-2228
(228) 396-2257
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0330637
—
MS
Enumeration date
10/18/2006
Last updated
08/22/2020
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