Individual
ASHLAN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
719 BROOKWAY BLVD, BROOKHAVEN, MS 39601
(601) 833-8509
Mailing address
132 FERGUSON ROAD, NEWHEBRON, MS 39140
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1557993
MS
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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