POLK'S CROSSGATE DISCOUNT DRUGS INC. (NPI# 1932138872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932138872 |
| Entity Type | Organization |
| Organization Name | POLK'S CROSSGATE DISCOUNT DRUGS INC. |
| Other Organization Name | POLK'S DISCOUNT DRUGS # 4 |
| Practice Address |
1866 Spillway Rd Brandon MS 39047-6063 |
| Practice Telephone | 6019924466 |
| Practice Fax Number | 6019924415 |
| Mailing Telephone | 6019924466 |
| Mailing Fax Number | 6019924415 |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2019-11-29 |
| Authorized Official Name | MR. ANDREW L HUBBARD (PIC) |
| Authorized Official Telephone | 6019924450 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 183500000X | Pharmacist | 02279 | MS | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 0030406 | 05 | |
| MS | 01402218 | 05 |
| Other Name | Type Code |
|---|---|
| POLK'S DISCOUNT DRUGS # 4 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306097902 | Polk's Crossgate Discount Drugs Inc. | Pharmacy | 1031 Star Rd, Brandon, MS 39042-9010 | 2008-10-02 |
| 1407872666 | Polk's Crossgate Discount Drugs Inc. | Pharmacy | 3119 Wesley Way Ste 6, Ste 6, Dothan, AL 36305-2000 | 2006-07-14 |
| 1518997410 | Polk's Crossgate Discount Drugs Inc. | Pharmacy | 1201 Highway 49 S, Ste 2, Richland, MS 39218-9425 | 2006-07-04 |
| Street Address |
1866 SPILLWAY RD |
| City | BRANDON |
| State | MS |
| Zip Code | 39047-6063 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396368783 | Siyuan Chen Kennedy | Counselor | 108 Sandstone Drive, Brandon, MS 39047 | 2020-05-20 |
| 1568019784 | Juarez Brown Emerson | Registered Nurse | 426 Pinebrook Circle, Brandon, MS 39047 | 2019-08-22 |
| 1649764127 | Specialty Diagnostics LLC | Family Medicine | 1149 Old Fannin Rd Ste 22, Brandon, MS 39047 | 2018-06-19 |
| 1528423035 | Kathlene Strangeman | Social Worker | 111 Lakeshore Dr Apt G403, Brandon, MS 39047 | 2015-12-28 |
| 1174935076 | Anthony Davis | Counselor | 198 Bellegrove Cir, Brandon, MS 39047 | 2014-05-27 |
| 1144659178 | Medical Foundation of Central Ms, Inc | Family Medicine | 1887 Spillway Rd., Brandon, MS 39047 | 2013-11-12 |
| 1437429941 | Picton Timothy Evans | Pharmacist | 150 B Cumberland Ed, Brandon, MS 39047 | 2012-01-01 |
| 1275828030 | Kathryn Audell Piburn | Nurse Practitioner | 1887 Spillway Rd Ste 140, Brandon, MS 39047 | 2011-06-09 |
| 1801930532 | Susanne Reynolds Moore | Dentist | 1149 Old Fannin Rd, Suite 26, Brandon, MS 39047 | 2007-02-16 |
| 1194898429 | Brookshire Grocery Company | Durable Medical Equipment & Medical Supplies | 143 Plaza Drive Ext, Attention Pharmacy Dept, Brandon, MS 39047 | 2006-11-16 |
| Find all providers in zip 39047 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306460886 | Amanda Nicole Cox | Pharmacist | 103 Langford Dr, Brandon, MS 39047-8304 | 2020-06-01 |
| 1942831144 | Uyen Vo | Pharmacist | 1611 Ledgestone Dr, Brandon, FL 33511-8321 | 2020-01-28 |
| 1962915405 | Kimsey O'neal | Pharmacist | 608 Marquette Rd, Brandon, MS 39042-3037 | 2017-11-07 |
| 1740792563 | Andrew Ort | Pharmacist | 1726 Wakefield Dr, Brandon, FL 33511-2312 | 2017-11-02 |
| 1194266262 | Cierra Jessica Harden | Pharmacist | 105 S Moon Ave, Brandon, FL 33511-5109 | 2017-03-09 |
| 1487011979 | Daliana Vazquez-nieves | Pharmacist | 808 Milano Cir Apt 103, Brandon, FL 33511-7026 | 2016-01-28 |
| 1598130791 | Larry Bowman | Pharmacist | 1002 Hollyberry Ct, Brandon, FL 33511-7650 | 2015-12-14 |
| 1306211958 | Deepak Gupta | Pharmacist | 1035 Professional Park Dr, Brandon, FL 33511-4886 | 2015-12-08 |
| 1164808861 | Derek Fluty | Pharmacist | 3427 Forest Bridge Cir, Brandon, FL 33511-8120 | 2015-08-04 |
| 1801272786 | Nancy Ann Striker | Pharmacist | 517 N Parsons Ave, Brandon, FL 33510-3611 | 2015-08-03 |
| Find all providers in BRANDON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.