Individual
MR. RANDALL CHARLES JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1505 HIGHWAY 43 S, PICAYUNE, MS 39466-9297
(601) 889-9509
Mailing address
1505 HIGHWAY 43 S, PICAYUNE, MS 39466-9297
(601) 889-9509
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13751
LA
Other
Enumeration date
10/29/2010
Last updated
10/29/2010
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