Organization
GIBSONS PHARMACY NO3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN W ANDERSON RPH (PRES)
(601) 582-0254
Entity
Organization
Contact information
Practice address
216 W CENTRAL AVE, PETAL, MS 39465-2016
(601) 582-0254
(601) 582-0255
Mailing address
216 W CENTRAL AVE, PETAL, MS 39465-2016
(601) 582-0254
(601) 582-0255
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00347
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00032018
—
MS
Enumeration date
03/14/2007
Last updated
08/16/2010
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