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General NPI Number Information
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NPI Number | 1164742334
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Entity Type | Organization
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Legal Business Name | GULF PHARMACY CORP
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 340 W 23RD ST SUITE D2
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City | PANAMA CITY
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State | FL
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Zip | 32405-7600
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Country | US
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Telephone | 850-215-9900
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Fax | 850-215-3344
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Provider Business Mailing Address
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Address Line | PO BOX 15473
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City | PANAMA CITY
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State | FL
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Zip | 32406-5473
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Country | US
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Telephone | 850-615-1000
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Fax | 850-215-3344
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Authorized Official
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Title or Position | OWNER
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Name | MAGED SHALABY
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Credential |
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Telephone | 347-579-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH24680
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License Number State | FL
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