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5001 Hardy St Ste 8 Hattiesburg MS 39402-1308 | |
| (601) 307-5339 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Pharmacy |
| Location | 5001 Hardy St Ste 8, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Jacob Cornelius Parker (SPECIALIST TECHNOLOGIST) |
| Authorized Official Contact | 6502530000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3301 N Milwaukee St Denver CO 80205-4322 Ph: (650) 253-0000 | 5001 Hardy St Ste 8 Hattiesburg MS 39402-1308 Ph: (601) 307-5339 |
| NPI Number | 1255999835 |
|---|---|
| Provider Enumeration Date | 05/30/2019 |
| Last Update Date | 09/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255999835 | NPI | - | NPPES |
| 587539997 | Medicaid | MS |
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