Organization
STATE LINE RX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELLIE HICKS SLP-CCC (PHARMACY MANAGER)
(601) 394-8064
Entity
Organization
Contact information
Practice address
194 MAIN ST, STATE LINE, MS 39362-9600
(601) 848-7866
(601) 848-7866
Mailing address
PO BOX 159, STATE LINE, MS 39362-0159
(601) 848-7866
(601) 848-7866
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
09/27/2025
Last updated
09/27/2025
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