Individual
MR. JETT LAVERN MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
433 W HILL ST, THOMSON, GA 30824-2116
(706) 595-4842
(706) 595-8665
Mailing address
PO BOX 381, 41 CRESTVIEW AVE, WARRENTON, GA 30828-0381
(706) 465-9209
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13447
GA
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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