Individual
DR. DOMONIQUE VAN BUREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
805 E RIVER PL, JACKSON, MS 39202-3486
(601) 500-7660
Mailing address
805 E RIVER PL, JACKSON, MS 39202-3486
(601) 500-7660
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PST.020307
LA
183500000X
Pharmacist
Primary
T-15181
MS
Other
Enumeration date
10/01/2012
Last updated
03/04/2021
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