Organization
GW PHARMACY LLC
Active
Other names
GW Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
WAYMON TIGRETT (OWNER)
(601) 573-7788
Entity
Organization
Contact information
Practice address
201 N COLLEGE ST STE 101, BRANDON, MS 39042-4439
(601) 825-2897
Mailing address
201 N COLLEGE ST, SUITE 101 BOX 9, BRANDON, MS 39042-4437
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
08886/02.6
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2588284
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/11/2011
Last updated
05/16/2011
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