Provider Demographics
NPI:1861564775
Name:BISHOP, BETTY GAIL (RPH)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:GAIL
Last Name:BISHOP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 HEWES AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1002
Mailing Address - Country:US
Mailing Address - Phone:228-326-5228
Mailing Address - Fax:
Practice Address - Street 1:1444 E PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3521
Practice Address - Country:US
Practice Address - Phone:228-896-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE05652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist