Organization
OKOLONA PHARMACY LLC
Active
Other names
Okolona Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TONY SMITH (OWNER)
(901) 831-8669
Entity
Organization
Contact information
Practice address
210 W MAIN ST, OKOLONA, MS 38860-1425
(662) 447-0300
(662) 447-0130
Mailing address
210 W MAIN ST, OKOLONA, MS 38860-1425
(662) 447-0300
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14335/1.1
MS
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00479277
—
MS
01
—
2151821
PK
—
Enumeration date
04/30/2015
Last updated
05/23/2023
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