Organization
WALLACE DRUG COMPANY INC
Active
Other names
WALLACE DISCOUNT DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH ROBERTSON (OWNER/PIC)
(601) 428-1277
Entity
Organization
Contact information
Practice address
520 N MAGNOLIA ST, LAUREL, MS 39440-3559
(601) 428-1277
(601) 428-1898
Mailing address
520 N MAGNOLIA ST, LAUREL, MS 39440-3559
(601) 428-4334
(601) 428-1898
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0162611
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050522
PK
—
05
—
34908
—
MS
Enumeration date
03/05/2007
Last updated
01/20/2025
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