Provider Demographics
NPI:1538717459
Name:SQUARE DRUGS, LLC
Entity type:Organization
Organization Name:SQUARE DRUGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:ROWSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-783-6100
Mailing Address - Street 1:126 COURT SQUARE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921
Mailing Address - Country:US
Mailing Address - Phone:662-783-6100
Mailing Address - Fax:662-783-3007
Practice Address - Street 1:126 COURT SQUARE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921
Practice Address - Country:US
Practice Address - Phone:662-783-6100
Practice Address - Fax:662-783-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05736805Medicaid