| NPI | 1457803421 |
|---|---|
| Doing Business As | GULF SOUTH PHARMACY |
| Entity Type | Organization |
| Authorized Contact | TAMMIE MISKIMINS Manager, Licensing 817-572-0009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: LA PHY.007385) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2016-10-26 |