Organization
UNIVERSITY PAVILION PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN HARTNESS COBB R.PH. (PHARMACY SUPERVISOR)
(601) 984-2058
Entity
Organization
Contact information
Practice address
1410 E WOODROW WILSON DR, JACKSON, MS 39216
(601) 984-2058
(601) 984-2063
Mailing address
1410 E WOODROW WILSON DR, JACKSON, MS 39216
(601) 984-2058
(601) 984-2063
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
02188
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30158
—
MS
Enumeration date
02/14/2007
Last updated
09/07/2007
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