Individual
BILL E BLALACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
218 S WHITWORTH AVE, BROOKHAVEN, MS 39601-3343
(601) 835-0370
(601) 835-3376
Mailing address
218 S WHITWORTH AVE, BROOKHAVEN, MS 39601-3343
(601) 835-0370
(601) 835-3376
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
5911
MS
183500000X
Pharmacist
Primary
PD05554
AR
Other
Enumeration date
10/06/2010
Last updated
10/06/2010
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