Provider Demographics
NPI:1124112420
Name:T AND B ENTERPRISES
Entity type:Organization
Organization Name:T AND B ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ MANAGING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-365-5036
Mailing Address - Street 1:735 S FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824-2612
Mailing Address - Country:US
Mailing Address - Phone:662-365-5036
Mailing Address - Fax:662-365-8083
Practice Address - Street 1:735 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-2612
Practice Address - Country:US
Practice Address - Phone:662-365-5036
Practice Address - Fax:662-365-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS008893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00039993Medicaid
MS0723180001Medicare NSC