Individual
MISS LUCILLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
(601) 364-5193
Mailing address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
(601) 364-5193
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
R07490
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2518794
NABP
MS
Enumeration date
10/17/2006
Last updated
07/08/2007
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