Individual
THIRSTON IVORY DIVINITY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
204 HIGHWAY 80 E, CLINTON, MS 39056-4716
(601) 926-1116
(601) 926-1234
Mailing address
204 HIGHWAY 80 E, CLINTON, MS 39056-4716
(601) 926-1116
(601) 926-1234
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-12650
MS
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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