Provider Demographics
NPI:1295397248
Name:SGSP, INC
Entity Type:Organization
Organization Name:SGSP, INC
Other - Org Name:LYMAN PHARMACY 49
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:SUMMER
Authorized Official - Last Name:GALLOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-234-6236
Mailing Address - Street 1:20117 BOX CV
Mailing Address - Street 2:
Mailing Address - City:SAUCIER
Mailing Address - State:MS
Mailing Address - Zip Code:39574-8702
Mailing Address - Country:US
Mailing Address - Phone:228-234-6236
Mailing Address - Fax:228-831-9951
Practice Address - Street 1:12372 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2741
Practice Address - Country:US
Practice Address - Phone:228-234-6236
Practice Address - Fax:228-831-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-30
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy