Provider Demographics
NPI:1487159299
Name:COMMUNITY DISCOUNT PHARMACY INC
Entity type:Organization
Organization Name:COMMUNITY DISCOUNT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:KIDDER
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:662-562-5268
Mailing Address - Street 1:305 NORFLEET DR
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2205
Mailing Address - Country:US
Mailing Address - Phone:662-562-5268
Mailing Address - Fax:662-562-6136
Practice Address - Street 1:100 N FRONT ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2136
Practice Address - Country:US
Practice Address - Phone:662-562-5268
Practice Address - Fax:662-562-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS012823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175855OtherPK
MS00095117Medicaid