Individual
MARY HATHORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
107 HIGHWAY 80 E, CLINTON, MS 39056-4738
(601) 925-6343
Mailing address
107 HIGHWAY 80 E, CLINTON, MS 39056-4738
(601) 925-6343
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
T8072
MS
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
12/27/2019
Last updated
03/13/2020
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