Individual
MR. CLARENCE LEE MIDDLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
122 S FRONT ST, ELLISVILLE, MS 39437-3118
(601) 477-8587
Mailing address
202 S COURT ST, ELLISVILLE, MS 39437-3112
(864) 710-2992
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
T-13037
MS
Other
Enumeration date
06/04/2017
Last updated
06/04/2017
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