# MEMORIAL HOSPITAL AT GULFPORT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Memorial Outpatient Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073063327
- **Authorized official:** JENNIFER DUMAL (COO)
- **Authorized official phone:** (228) 865-3542

## Contact information

- **Practice address:** 4500 13TH ST, GULFPORT, MS 39501-2515
- **Practice address phone:** (228) 865-3525
- **Practice address fax:** (228) 865-3618
- **Mailing address:** PO BOX 1810, GULFPORT, MS 39502-1810
- **Mailing address phone:** (228) 865-3525
- **Mailing address fax:** (228) 865-3618

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 14971 | MS | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/11/2016
- **Last updated:** 12/17/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05383367 | — | MS |
| 01 | — | 2162560 | PK | — |