Individual
NIKKI RED WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
122 S FRONT ST, ELLISVILLE, MS 39437-3118
(601) 477-8587
(601) 477-3222
Mailing address
122 S FRONT ST, ELLISVILLE, MS 39437-3118
(601) 477-8587
(601) 477-3222
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0013/01.1
MS
183500000X
Pharmacist
Primary
E-03592
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330679
—
MS
Enumeration date
07/15/2008
Last updated
07/15/2008
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