Organization
PICKLE'S DRUG STORE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT W PICKLE JR. RPH (PRESIDENT)
(662) 289-1112
Entity
Organization
Contact information
Practice address
100 N JACKSON ST, KOSCIUSKO, MS 39090-3730
(662) 289-1112
(662) 289-5061
Mailing address
100 N JACKSON ST, KOSCIUSKO, MS 39090-3730
(662) 289-1112
(662) 289-5061
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00214/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330210
—
MS
05
—
05377705
—
MS
01
—
2505014
NCPDP
MS
Enumeration date
07/12/2006
Last updated
08/22/2020
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