Organization
MEMORIAL HOSPITAL AT GULFPORT
Active
Other names
Memorial Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER DUMAL (COO)
(228) 865-3542
Entity
Organization
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 865-3525
(228) 865-3618
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 865-3525
(228) 865-3618
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14971
MS
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05383367
—
MS
01
—
2162560
PK
—
Enumeration date
10/11/2016
Last updated
12/17/2019
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