Gentex Pharma

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

06677/6.1 Issued in MS

Legal business name

GENTEX PHARMA

Practice address

121 Marketridge Dr
Suite C
Ridgeland, MS 39157-6027

Phone

(601) 990-9497

Fax

(601) 510-9318

NPI assigned

May 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ford Jennings Mundy, PERSON IN CHARGE

Title

Owner

Phone

(870) 243-1687

Specialties & licenses 1

Addresses

Other names 1

• Gentex Pharma LLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1114373586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 MARKETRIDGE DR",
            "address_2": "SUITE C",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576027",
            "telephone_number": "601-990-9497",
            "fax_number": "601-510-9318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 MARKETRIDGE DR",
            "address_2": "SUITE C",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576027",
            "telephone_number": "601-990-9497",
            "fax_number": "601-510-9318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENTEX PHARMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "MUNDY",
        "authorized_official_first_name": "FORD",
        "authorized_official_middle_name": "JENNINGS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-243-1687",
        "authorized_official_credential": "PERSON IN CHARGE"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "MS",
            "license": "06677/6.1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentex Pharma LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-Pharmacy Dispensing Site in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Non-Pharmacy Dispensing Site in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.