Organization
CALVERTS DRUG STORE LLC
Active
Other names
CALVERTS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS PAYNE (OWNER)
(228) 257-9334
Entity
Organization
Contact information
Practice address
2561 PASS RD, STE A, BILOXI, MS 39531-2125
(228) 388-1411
(228) 388-1484
Mailing address
2561 PASS RD, STE A, BILOXI, MS 39531-2125
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00420/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030643
—
MS
01
—
2502210
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/27/2007
Last updated
05/04/2009
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