Provider Demographics
NPI:1336215946
Name:G & T PHARMACEUTICAL INC
Entity type:Organization
Organization Name:G & T PHARMACEUTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-894-3355
Mailing Address - Street 1:148A W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-3020
Mailing Address - Country:US
Mailing Address - Phone:601-894-3355
Mailing Address - Fax:
Practice Address - Street 1:148A W GREEN ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-3020
Practice Address - Country:US
Practice Address - Phone:601-894-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04006 02.5333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0440492Medicaid
MS0440492Medicaid
MS4258590001Medicare ID - Type Unspecified