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Organization
MEMORIAL HOSPITAL AT GULFPORT
Active
Organization
MEMORIAL HOSPITAL AT GULFPORT
Active
Other names
Memorial Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER DUMAL (COO)
(228) 865-3542
Entity
Organization
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 865-3525
(228) 865-3618
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 865-3525
(228) 865-3618
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
14971
MS
3336C0004X
Compounding Pharmacy
—
NULL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05383367
—
MS
01
—
2162560
PK
—
Enumeration date
10/11/2016
Last updated
12/17/2019
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