Healthcare Provider Details

I. General information

NPI: 1366556326
Provider Name (Legal Business Name): GPRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 SIMPSON HIGHWAY 149
MAGEE MS
39111-3416
US

IV. Provider business mailing address

408 SIMPSON HIGHWAY 149
MAGEE MS
39111-3416
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-2627
  • Fax: 601-849-2558
Mailing address:
  • Phone: 601-849-2627
  • Fax: 601-849-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number05213/2.6
License Number StateMS

VIII. Authorized Official

Name: BRINSON PORK
Title or Position: OWNER
Credential: RPH
Phone: 601-849-2533