Individual
SAMANTHA COPPOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3341 HALLS FERRY RD, VICKSBURG, MS 39180-5338
(601) 661-9340
Mailing address
1707 EAST AVE, VICKSBURG, MS 39180-3722
(971) 295-9458
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-100344
MS
Other
Enumeration date
08/16/2021
Last updated
08/16/2021
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