Individual
BRENDA LYON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1235 MAIN ST, SOUTHAVEN, MS 38671-1429
(662) 342-5757
Mailing address
169 COUNTRY CLUB LN, SENATOBIA, MS 38668-4160
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-09081
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E-09081
MISSISSIPPI STATE BOARD OF PHARMACY
MS
Enumeration date
03/27/2019
Last updated
03/27/2019
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