| Organization Name: | CITY DRUG STORE OF HAZLEHURST, INC. |
| NPI Number: | 1467532663 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL HENRY ROSE (OWNER) |
| Mailing Address: | 218 Caldwell Dr Hazlehurst |
| State: | MS US |
| Postal Code: | 390832712 |
| Phone Number: | 6018941222 |
| Fax Number: | 6018941522 |
| NPI Enumeration Date: | 10/16/2006 |
| NPI Last Update Date: | 06/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 002093 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |