Individual
MR. JOE RAY BOURN SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
31 FRONT ST, COFFEEVILLE, MS 38922
(662) 675-2775
(662) 675-8477
Mailing address
PO BOX 279, COFFEEVILLE, MS 38922
(662) 675-2775
(662) 675-8477
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E5330
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0093220
—
MS
01
—
2502880
NABP # FED
—
Enumeration date
02/05/2007
Last updated
07/08/2007
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