Organization
POLKS DISCOUNT DRUGS #2
Active
Other names
polks crossgates discount drugs inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH WAYNE WILLOUGHBY RPH (PHARMACIST/MANAGER)
(601) 845-8610
Entity
Organization
Contact information
Practice address
101 49 PLACE, FLORENCE, MS 39073
(601) 845-8610
(601) 845-8650
Mailing address
101 49 PL, P.O. BOX 266, FLORENCE, MS 39073-8080
(601) 845-8610
(601) 845-8650
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
02014
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030485
—
MS
05
—
00040389
—
MS
Enumeration date
09/13/2006
Last updated
04/29/2015
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