Healthcare Provider Details

I. General information

NPI: 1134443385
Provider Name (Legal Business Name): GWENDOLYN COLEMAN GARROR R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GWENDOLYN COLEMAN R.PH.

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 FAIRMOUNT DRIVE
CLINTON MS
39056
US

IV. Provider business mailing address

132 FAIRMOUNT DRIVE
CLINTON MS
39056-2050
US

V. Phone/Fax

Practice location:
  • Phone: 601-988-1710
  • Fax: 601-988-1711
Mailing address:
  • Phone: 601-988-1710
  • Fax: 601-988-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051923-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-7907
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: