Individual
MR. TERRY L MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
2996 CHURCH RD E, SOUTHAVEN, MS 38671-9825
(662) 949-4418
Mailing address
2996 CHURCH RD E, SOUTHAVEN, MS 38671-9825
(662) 349-4418
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6753
MS
Other
Enumeration date
11/12/2020
Last updated
11/12/2020
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