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General NPI Number Information
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NPI Number | 1295397248
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Entity Type | Organization
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Legal Business Name | SGSP, INC
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Dates
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Enumeration Date | 06/30/2019
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Last Update Date | 07/04/2019
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Provider Practice Location Address
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Address Line | 12372 HIGHWAY 49
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City | GULFPORT
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State | MS
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Zip | 39503-2741
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Country | US
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Telephone | 228-234-6236
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Fax | 228-831-9951
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Provider Business Mailing Address
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Address Line | 20117 BOX CV
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City | SAUCIER
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State | MS
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Zip | 39574-8702
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Country | US
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Telephone | 228-234-6236
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Fax | 228-831-9951
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHERINE SUMMER GALLOTTE
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Credential |
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Telephone | 228-234-6236
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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 |
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License Number State |
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