Provider Demographics
NPI:1811322753
Name:GOLDEN TRIANGLE PLANNING AND DEVELOPMENT DISTRICT
Entity type:Organization
Organization Name:GOLDEN TRIANGLE PLANNING AND DEVELOPMENT DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-324-7860
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-0828
Mailing Address - Country:US
Mailing Address - Phone:662-320-2011
Mailing Address - Fax:
Practice Address - Street 1:301 CC CLARK
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-320-2011
Practice Address - Fax:662-320-2004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN TRIANGLE PLANNING AND DEVELOPMENT DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-11
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF12603305S00000X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No305S00000XManaged Care OrganizationsPoint of Service
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy