Individual
MR. KENNETH DALE HARRELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
504 WEST MAIN STREET, STE 1, WEST POINT, MS 39773-2759
(662) 494-4748
(662) 494-2565
Mailing address
1213 OAK DRIVE, WEST POINT, MS 39773-3929
(662) 494-4748
(662) 494-2565
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E5522
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00091456
—
MS
01
—
2515483
MABP
MS
Enumeration date
08/05/2006
Last updated
07/08/2007
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