Individual
MICHELLE BOUDREAU MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
715 BONITA DR, MERIDIAN, MS 39301-4603
(601) 286-6035
Mailing address
6545 A C BROWN RD, MERIDIAN, MS 39305-9511
(607) 426-5001
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
T-16401
MS
Other
Enumeration date
01/21/2022
Last updated
01/21/2022
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