Individual
JORDAN KENNEDY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11228 OLD 63 S, LUCEDALE, MS 39452-4945
(601) 947-4287
Mailing address
8001 COUNTY ROAD 514, MERIDIAN, MS 39301-9276
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-15508
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E-15508
LICENSE NUMBER
MS
Enumeration date
08/18/2018
Last updated
08/18/2018
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