Individual
WANDA COOK HARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1502 GOODMAN RD W, HORN LAKE, MS 38637-1407
(662) 342-6436
(662) 342-6667
Mailing address
2231 EL DORADO DR, NESBIT, MS 38651-9569
(662) 654-1790
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
18175
AL
183500000X
Pharmacist
36488
TN
183500000X
Pharmacist
Primary
E06619
MS
183500000X
Pharmacist
PST.020401
LA
183500000X
Pharmacist
R15569
OK
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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