Individual
MRS. VIRGINIA LEO BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
6010 CASTLE RD, VICKSBURG, MS 39180-9310
(601) 636-1718
Mailing address
6010 CASTLE RD, VICKSBURG, MS 39180-9310
(601) 636-1718
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-05403
MS
Other
Enumeration date
12/19/2019
Last updated
12/19/2019
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