Organization
GEORGE COUNTY PHARMACY
Active
Other names
George County Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CARMAN WALLEY (DOP)
(601) 673-6181
Entity
Organization
Contact information
Practice address
92 RATLIFF ST, LUCEDALE, MS 39452-6537
(601) 673-6181
(601) 766-4293
Mailing address
92 RATLIFF ST, LUCEDALE, MS 39452-6537
(601) 673-6181
(601) 766-4293
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
12325/2.6
MS
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140621
PK
—
Enumeration date
08/14/2013
Last updated
08/14/2013
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