Organization
STATE VETERANS AFFAIRS BOARD
Active
Parent organization
STATE VETERANS AFFAIRS BOARD
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE VETERANS AFFAIRS BOARD
Authorized official
VELEKA GRADY PHARM.D (PHARMACIST)
(601) 353-6142
Entity
Organization
Contact information
Practice address
4607 LINDBERGH DR, JACKSON, MS 39209-3855
(601) 353-6142
Mailing address
4607 LINDBERGH DR, JACKSON, MS 39209-3855
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
3336I0012X
Institutional Pharmacy
—
—
Other
Enumeration date
04/17/2018
Last updated
11/10/2022
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