Individual
MR. JESSE IVY GARRETT III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 EAST WOODROW WILSON DRIVE, JACKSON, MS 39216-9765
(601) 364-1555
Mailing address
114 CEDAR CREST DRIVE, CLINTON, MS 39056-9765
(601) 924-1500
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E6146
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E6146
RPH LICENSE NUMBER
MS
Enumeration date
10/02/2006
Last updated
07/08/2007
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