Organization
SOUTHWEST DRUGSTORE OF MS INC
Active
Other names
SOUTHWEST DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
OSHER MOORE (OWNER)
(601) 898-7885
Entity
Organization
Contact information
Practice address
1601 ADELINE ST, HATTIESBURG, MS 39401-6267
(601) 582-2481
(601) 545-3662
Mailing address
1601 ADELINE ST, HATTIESBURG, MS 39401-6267
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0077500
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0036251
—
MS
01
—
2500913
OTHER ID NUMBER
—
Enumeration date
02/07/2007
Last updated
09/25/2007
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