Individual
DEWITT DIVINITY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1500 E WOODROW WILSON DR, JACKSON, MS 39216-5199
(601) 364-1555
(601) 364-1578
Mailing address
1500 E WOODROW WILSON DR, JACKSON, MS 39216-5199
(601) 364-1555
(601) 364-1578
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
39763
TX
183500000X
Pharmacist
Primary
T-09554
MS
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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