# GENTEX PHARMA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gentex Pharma LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114373586
- **Authorized official:** FORD JENNINGS MUNDY PERSON IN CHARGE (OWNER)
- **Authorized official phone:** (870) 243-1687

## Contact information

- **Practice address:** 121 MARKETRIDGE DR, SUITE C, RIDGELAND, MS 39157-6027
- **Practice address phone:** (601) 990-9497
- **Practice address fax:** (601) 510-9318
- **Mailing address:** 121 MARKETRIDGE DR, SUITE C, RIDGELAND, MS 39157-6027
- **Mailing address phone:** (601) 990-9497
- **Mailing address fax:** (601) 510-9318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 06677/6.1 | MS | Yes |

## Other

- **Enumeration date:** 05/04/2016
- **Last updated:** 05/04/2016