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Individual

TIFFANY MEDLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1515 HIGHWAY 278 E, AMORY, MS 38821-5909
(662) 256-1590
Mailing address
200 SAWGRASS RD, STARKVILLE, MS 39759-7696
(912) 414-0736

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
PS59609
FL
183500000X
Pharmacist
RPH028123
GA
183500000X
Pharmacist
Primary
T-15890
MS

Other

Enumeration date
11/09/2020
Last updated
11/09/2020
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