Individual
WILLETA LUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
977 ELLIS AVE, JACKSON, MS 39209-6256
(601) 944-9965
(601) 969-6419
Mailing address
106 TRACEY CV, MADISON, MS 39110-6045
(601) 951-4177
(601) 944-9965
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-14598
MS
Other
Enumeration date
08/20/2020
Last updated
08/20/2020
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