SUMRALL DRUG STORE LLC NPI 1275613952

NPI Details

SUMRALL DRUG STORE LLC is a community/retail pharmacy pharmacy in Sumrall, MS. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. SUMRALL DRUG STORE LLC NPI is 1275613952. The provider is registered as an organization entity type.
The provider Is Doing Business As Sumrall Drug Store.

The provider's business location address is:

1109 HWY 42
SUMRALL, MS
ZIP 39482-246
Phone: (601) 758-4243
Fax: (601) 758-4999

The provider's authorized official is Beau Haden .
The authorized official title is Owner and has the following contact phone number (601) 758-4243.

The CLIA number assigned to this NPI record is 25D1088225 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

• Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count (HCPCS:K1034)
• Administration of influenza virus vaccine (HCPCS:G0008)
• Influenza vaccine split virus, preservative free (HCPCS:90662)
• Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 100 mcg/0.5ml dosage; first dose (HCPCS:0011A)
• Coronavirus vaccine 13 (HCPCS:91312)
• Fee covid-19 vac 13 res (HCPCS:0124A)
• Fee covid-19 vac 14 res (HCPCS:0134A)
• Coronavirus vaccine 14 (HCPCS:91313)
• Adm sarscv2 30mcg trs-sucr 1 (HCPCS:0051A)
• Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 100 mcg/0.5ml dosage; second dose (HCPCS:0012A)
• Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; first dose (HCPCS:0001A)
• Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; second dose (HCPCS:0002A)

The enumeration date for this NPI number is 10/16/2006 and was last updated on 12/7/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.