Individual
BENITA PRINGLE ERVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1497 CANTON MART RD, JACKSON, MS 39211
(601) 956-2421
Mailing address
204 FLOWERS LANE, BRANDON, MS 39047
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E09024
MS
Other
Enumeration date
09/28/2012
Last updated
09/28/2012
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