Organization
BRENTS DRUGS OF BELHAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY CALVERT (PRES)
(601) 355-5114
Entity
Organization
Contact information
Practice address
902B E FORTIFICATION ST, JACKSON, MS 39202
(601) 355-5114
(601) 352-9282
Mailing address
902B E FORTIFICATION ST, JACKSON, MS 39202
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
06747
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0033061
—
MS
01
—
2586292
OTHER ID NUMBER
—
Enumeration date
11/15/2006
Last updated
07/20/2007
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