Organization
MACON CITY DRUG STORE, INC.
Active
Parent organization
MACON CITY DRUG STORE, INC.
Other names
City Drug Store
Organization subpart
Yes
Provider details
NPI number
Legal business name
MACON CITY DRUG STORE, INC.
Authorized official
BECKY GENE WATT (DME PROVIDER)
(662) 726-5143
Entity
Organization
Contact information
Practice address
3281 JEFFERSON ST, MACON, MS 39341-2279
(662) 726-5143
(662) 726-5183
Mailing address
PO BOX 424, MACON, MS 39341-0424
(662) 726-5143
(662) 726-5183
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0012501.1
MS
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00039888
—
MS
01
—
00440507
MEDICAID DME #
MS
01
—
2505367
NABP #
MS
Enumeration date
06/28/2007
Last updated
01/26/2024
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