Organization
GOODMAN PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY GLENN (PIC/MANAGING MEMBER)
(662) 580-1035
Entity
Organization
Contact information
Practice address
6888 GOODMAN RD STE 104, OLIVE BRANCH, MS 38654-8759
(662) 580-1035
Mailing address
6888 GOODMAN RD STE 104, OLIVE BRANCH, MS 38654-8759
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
12429
MS
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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