Gibson Pharmacy of Grenada, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

00662 Issued in MS

Legal business name

GIBSON PHARMACY OF GRENADA, INC

Practice address

710 Lakeview Dr
Grenada, MS 38901-4346

Phone

(662) 226-6589

Fax

(662) 226-1604

NPI assigned

Feb 10, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Fred S Fortenberry, RPH

Title

Pres

Phone

(662) 226-6589

Specialties & licenses 1

Addresses

Other names 1

• Gibson Pharmacy Other name

Locations

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

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861533820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 LAKEVIEW DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389014346",
            "telephone_number": "662-226-6589",
            "fax_number": "662-226-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 LAKEVIEW DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389014346",
            "telephone_number": "662-226-6589",
            "fax_number": "662-226-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON PHARMACY OF GRENADA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORTENBERRY",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "662-226-6589",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "00662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gibson Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amy Floyd, FNP
• Mary Anne Frank-Tarsi, M.D.
• Rebecca J Franklin, FNP-C
• Sarah Katherine Gantz Pannel, D.O
• George M Miller Jr MD PC
• Lillie Gibson, RN
• Justice Aaron Gondwe, M.D.
• Goss Mental Health and Wellness PLLC
• Jennifer Lee Goss, FNP
• Grace Health & Rehab of Grenada, LLC

• Community/Retail Pharmacy in Grenada, MS
• Providers in Grenada, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.