Individual
MR. JACK LARRY SANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R PH
Contact information
Practice address
3160 AUDUBON DR, LAUREL, MS 39440
(601) 428-0688
(601) 428-0689
Mailing address
PO BOX 8324, LAUREL, MS 39441-8324
(601) 729-4407
(601) 428-0689
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-06744
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E-06744
STATE LICENSE NUMBER
MS
Enumeration date
10/20/2006
Last updated
07/08/2007
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