# OAK PLACE PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OAK PLACE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568590321
- **Authorized official:** MR. TERRY J RALEY SR. REG PHARMACIST (OWNER)
- **Authorized official phone:** (228) 864-6647

## Contact information

- **Practice address:** 1311 BROAD AVE, GULFPORT, MS 39501-2419
- **Practice address phone:** (228) 864-6647
- **Practice address fax:** (228) 864-6698
- **Mailing address:** 1311 BROAD AVE, GULFPORT, MS 39501-2419
- **Mailing address phone:** (228) 864-6647
- **Mailing address fax:** (228) 864-6698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 0106201.1 | MS | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00092053 | — | MS |
| 01 | — | 2508414 | NABP | — |