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General NPI Number Information
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NPI Number | 1134568942
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Entity Type | Organization
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Legal Business Name | GOOD MEDICINE
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Dates
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Enumeration Date | 06/14/2013
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 20006 HIGHWAY 53 STE C
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City | GULFPORT
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State | MS
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Zip | 39503-7843
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Country | US
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Telephone | 228-831-9997
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Fax | 228-831-9951
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Provider Business Mailing Address
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Address Line | 20006 HIGHWAY 53 STE C
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City | GULFPORT
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State | MS
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Zip | 39503-7843
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Country | US
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Telephone | 228-831-9997
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Fax | 228-831-9951
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Authorized Official
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Title or Position | PIC
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Name | MICHAEL GALLOTTE
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Credential | PHARMD
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Telephone | 228-831-9997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 12380/1.1
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License Number State | MS
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