Individual
JANA WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5148 HIGHWAY 51 N, SENATOBIA, MS 38668-1720
(662) 562-9366
Mailing address
5148 HIGHWAY 51 N, SENATOBIA, MS 38668-1720
(662) 562-9366
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-09026
MS
Other
Enumeration date
09/23/2011
Last updated
09/23/2011
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