Organization
TYSON DRUGS INC
Active
Other names
TYSON DRUGS INC
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LOMENICK (OWNER)
(662) 252-2321
Entity
Organization
Contact information
Practice address
145 E VAN DORN AVE, HOLLY SPRINGS, MS 38635-3025
(662) 252-2321
(662) 252-1656
Mailing address
145 E VAN DORN AVE, HOLLY SPRINGS, MS 38635-3025
(662) 252-2321
(662) 252-1656
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
00500/1.1
MS
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0034797
—
MS
01
—
2043239
PK
—
Enumeration date
06/17/2005
Last updated
01/07/2015
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