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General NPI Number Information
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NPI Number | 1972893006
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Entity Type | Organization
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Legal Business Name | GW PHARMACY LLC
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 201 N COLLEGE ST STE 101
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City | BRANDON
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State | MS
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Zip | 39042-4439
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Country | US
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Telephone | 601-825-2897
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Fax |
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Provider Business Mailing Address
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Address Line | 201 N COLLEGE ST SUITE 101 BOX 9
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City | BRANDON
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State | MS
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Zip | 39042-4437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WAYMON TIGRETT
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Credential |
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Telephone | 601-573-7788
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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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 08886/02.6
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License Number State | MS
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