Individual
CAROLINE BOYDSTUN FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
109 NORTHSIDE CENTER, KOSCIUSKO, MS 39090
(662) 289-3234
Mailing address
109 NORTHSIDE SHOPPING CENTER, KOSCIUSKO, MS 39090
(662) 803-2641
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-14947
MS
Other
Enumeration date
12/11/2017
Last updated
12/11/2017
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