Individual
CHARLES DYLAN KEVERYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
810 BRIDGEPORT DR, MADISON, MS 39110-9610
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-100206
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E-100206
PHARMACY LICENSE
MS
Enumeration date
07/16/2021
Last updated
11/13/2023
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