Individual
DR. MALLORY DE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
82 MAIN ST W, MEADVILLE, MS 39653-9320
(601) 384-3105
Mailing address
992 S CHURCH ST, BROOKHAVEN, MS 39601-4004
(601) 754-0057
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-12933
MS
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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