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General NPI Number Information
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NPI Number | 1215345087
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Entity Type | Organization
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Legal Business Name | GULF COAST VETERANS HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 07/24/2014
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Provider Practice Location Address
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Address Line | 400 VETERANS AVE
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City | BILOXI
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State | MS
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Zip | 39531-2410
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Country | US
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Telephone | 228-523-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 400 VETERANS AVE
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City | BILOXI
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State | MS
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Zip | 39531-2410
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Country | US
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Telephone | 228-523-5000
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MS. NICOLE LYNN RILEY
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Credential | PHARM.D.
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Telephone | 504-421-2820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | PST.020646
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License Number State | LA
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