Healthcare Provider Details

I. General information

NPI: 1659639896
Provider Name (Legal Business Name): GARDENS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WASHINGTON AVE
OCEAN SPRINGS MS
39564-4637
US

IV. Provider business mailing address

801 WASHINGTON AVE
OCEAN SPRINGS MS
39564-4637
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-5111
  • Fax: 228-818-5113
Mailing address:
  • Phone: 228-818-5111
  • Fax: 228-818-5113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number11134/1.1
License Number StateMS
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEMPSEY LEVI
Title or Position: PHARMACIST
Credential:
Phone: 228-818-5111