Organization
TYSON DRUGS INC
Active
Parent organization
TYSON DRUGS INC
Other names
Tysons Medical Center Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
TYSON DRUGS INC
Authorized official
MR. ROBERT HUDSON LOMENICK RPH (OWNER/ PHARMACIST)
(662) 252-1011
Entity
Organization
Contact information
Practice address
530 J M ASH DR, HOLLY SPRINGS, MS 38635-3238
(662) 252-1011
(662) 252-1189
Mailing address
530 J M ASH DR, HOLLY SPRINGS, MS 38635-3238
(662) 252-1011
(662) 252-1189
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
0432/01.1
MS
3336C0003X
Community/Retail Pharmacy
F04232
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330425
—
MS
01
—
2519354
NCPDP
—
Enumeration date
06/17/2005
Last updated
01/20/2012
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