Individual
JAMES EDDLEMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
465 STATELINE RD W, SOUTHAVEN, MS 38671-1611
(662) 393-3426
Mailing address
8814 BEATLINE RD, TUNICA, MS 38676-9603
(901) 568-1102
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
07251
MS
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
07251
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720626161
—
MS
Enumeration date
12/17/2019
Last updated
03/10/2020
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