Organization
GIBSON PHARMACY OF GRENADA, INC
Active
Other names
Gibson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRED S FORTENBERRY RPH (PRES)
(662) 226-6589
Entity
Organization
Contact information
Practice address
710 LAKEVIEW DR, GRENADA, MS 38901-4346
(662) 226-6589
(662) 226-1604
Mailing address
710 LAKEVIEW DR, GRENADA, MS 38901-4346
(662) 226-6589
(662) 226-1604
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00662
MS
Other
Enumeration date
02/10/2007
Last updated
08/22/2020
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