Individual
ALLEN ELLIOTT LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH.
Contact information
Practice address
4931 MAIN ST, MOSS POINT, MS 39563-2746
(228) 474-4663
(228) 474-5545
Mailing address
PO BOX 8647, MOSS POINT, MS 39562-0010
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
E-07228
MS
Other
Enumeration date
02/10/2021
Last updated
02/10/2021
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