Individual
MRS. JEAN ROSS SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
584 E MAIN ST, SUITE8-A, PHILADELPHIA, MS 39350-2342
(601) 656-5477
(601) 650-9882
Mailing address
12401 HIGHWAY 491 S, UNION, MS 39365-8540
(601) 656-5477
(601) 650-9882
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
N/A
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0040112
—
MS
Enumeration date
11/02/2006
Last updated
04/25/2008
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