Provider Demographics
NPI:1003388240
Name:CANTON DISCOUNT DRUGS LTC
Entity type:Organization
Organization Name:CANTON DISCOUNT DRUGS LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-859-3827
Mailing Address - Street 1:726 E PEACE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4731
Mailing Address - Country:US
Mailing Address - Phone:601-859-3827
Mailing Address - Fax:601-859-3829
Practice Address - Street 1:726 E PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4731
Practice Address - Country:US
Practice Address - Phone:601-859-3827
Practice Address - Fax:601-859-3829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANTON DISCOUNT DRUGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00094684Medicaid