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General NPI Number Information
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NPI Number | 1457479438
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Entity Type | Organization
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Legal Business Name | TAYLOR HARRIS DRUG STORE
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1908 30TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-4534
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Country | US
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Telephone | 228-868-1036
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Fax | 228-868-1355
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Provider Business Mailing Address
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Address Line | 1908 30TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-4534
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Country | US
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Telephone | 228-868-1036
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Fax | 228-868-1355
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Authorized Official
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Title or Position | CO-OWNER PHARMACIST
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Name | MR. MACK BENNIE HARRIS
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Credential | R.PH.
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Telephone | 228-868-1036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | MS
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