Organization
POLKS CROSSGATES DISCOUNT DRUGS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL SCOTT BYRD R.PH. (PHARMACIST)
(601) 825-8660
Entity
Organization
Contact information
Practice address
335 CROSSGATES BLVD, BRANDON, MS 39042-2602
(601) 825-8660
(601) 825-6983
Mailing address
335 CROSSGATES BLVD, BRANDON, MS 39042-2602
(601) 825-8660
(601) 825-6983
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
01619/01.2
MS
3336C0003X
Community/Retail Pharmacy
Primary
01619- 01.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00045115
—
MS
05
—
00095346
—
MS
Enumeration date
07/04/2006
Last updated
12/18/2012
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