Individual
DEWELL LAMAR JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5093 HARDY ST, HATTIESBURG, MS 39401
(601) 579-7465
Mailing address
5093 HARDY ST, HATTIESBURG, MS 39401
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P012606
MS
Other
Enumeration date
09/04/2012
Last updated
09/04/2012
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