Individual
MR. KENNETH WAYNE WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2195 HIGHWAY 49 S, FLORENCE, MS 39073-9420
(601) 260-4249
Mailing address
148 NORTHSHORE WAY, MADISON, MS 39110-7177
(601) 260-4249
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E08123
MS
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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