Organization
PICAYUNE DRUG CO., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW L FAILLA R PH (PRESIDENT)
(601) 798-4846
Entity
Organization
Contact information
Practice address
110 HIGHWAY 11 N, PICAYUNE, MS 39466-3312
(601) 798-4846
(601) 798-4825
Mailing address
PO BOX 10, PICAYUNE, MS 39466-0010
(601) 798-4846
(601) 798-4825
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
055-05477-9
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00045164
—
MS
Enumeration date
06/26/2006
Last updated
04/12/2021
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