Healthcare Provider Details

I. General information

NPI: 1306888037
Provider Name (Legal Business Name): PATIENT CARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 E PASS RD
GULFPORT MS
39507-3805
US

IV. Provider business mailing address

318 E LOCKWOOD ST
COVINGTON LA
70433-2914
US

V. Phone/Fax

Practice location:
  • Phone: 228-604-4555
  • Fax: 228-896-0099
Mailing address:
  • Phone: 985-871-8701
  • Fax: 985-871-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number05948/02.5
License Number StateMS

VIII. Authorized Official

Name: MRS. SUSAN A GUTHRIE
Title or Position: PRESIDENT
Credential:
Phone: 985-871-8701