Organization
PANOLA PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER SULLIVANT (VICE PRESIDENT/OWNER)
(662) 934-3039
Entity
Organization
Contact information
Practice address
440 HIGHWAY 6 E, BATESVILLE, MS 38606-3000
(662) 855-1204
(662) 855-1218
Mailing address
440 HIGHWAY 6 E, BATESVILLE, MS 38606-3000
(662) 934-3039
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004734891
—
MS
Enumeration date
08/27/2019
Last updated
03/21/2025
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