# GW PHARMACY LLC

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

## Provider details

- **NPI number:** 1972893006
- **Authorized official:** WAYMON TIGRETT (OWNER)
- **Authorized official phone:** (601) 573-7788

## Contact information

- **Practice address:** 201 N COLLEGE ST STE 101, BRANDON, MS 39042-4439
- **Practice address phone:** (601) 825-2897
- **Mailing address:** 201 N COLLEGE ST, SUITE 101 BOX 9, BRANDON, MS 39042-4437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | 08886/02.6 | MS | Yes |

## Other

- **Enumeration date:** 04/11/2011
- **Last updated:** 05/16/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2588284 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |