Individual
MANSOUR SHABAZZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
977 ELLIS AVE, JACKSON, MS 39209-6256
(601) 944-9965
Mailing address
977 ELLIS AVE, JACKSON, MS 39209-6256
(601) 944-9965
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
T-15998
MS
Other
Enumeration date
10/12/2021
Last updated
10/12/2021
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