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Organization
MOORECO
Active
Organization
MOORECO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY M PERRY (RPH)
(601) 355-2438
Entity
Organization
Contact information
Practice address
1700 TERRY RD, JACKSON, MS 39204-3907
(601) 355-2438
(601) 948-0418
Mailing address
1700 TERRY RD, JACKSON, MS 39204-3907
(601) 355-2438
(601) 948-0418
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
01086/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0033278
—
MS
Enumeration date
09/29/2006
Last updated
08/22/2020
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