Organization
CANOVAS CITY DRUG STORE
Active
Other names
CITY DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES CONOVA (PRESIDENT)
(601) 888-3333
Entity
Organization
Contact information
Practice address
616 MAIN ST, WOODVILLE, MS 39669-9706
(601) 888-3333
(601) 888-6336
Mailing address
PO BOX 486, WOODVILLE, MS 39669-0486
(601) 888-3333
(601) 888-6336
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
01762/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030063
—
MS
05
—
1250686
—
LA
01
—
2043600
PK
—
Enumeration date
02/13/2007
Last updated
03/07/2016
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