Individual
TAMMY BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
46 PARKWAY LN, PETAL, MS 39465-3035
(601) 450-3673
Mailing address
46 PARKWAY LN, PETAL, MS 39465-3035
(601) 450-3673
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-07791
MS
Other
Enumeration date
06/07/2024
Last updated
06/07/2024
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