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Organization
SINGING RIVER MENTAL HEALTH MENTAL RETARDATION SERVICES
Active
Organization
SINGING RIVER MENTAL HEALTH MENTAL RETARDATION SERVICES
Active
Other names
Singing River Services Region XIV
Organization subpart
No
Provider details
NPI number
Authorized official
BRETTA ST ROMAIN (PHARMACIST-IN-CHARGE)
(228) 497-0690
Entity
Organization
Contact information
Practice address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(228) 497-0690
(228) 497-0794
Mailing address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(228) 497-0690
(228) 497-0794
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
14452/5.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01832567
—
MS
01
—
2153586
PK
—
Enumeration date
10/23/2014
Last updated
04/28/2016
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