Healthcare Provider Details

I. General information

NPI: 1518882745
Provider Name (Legal Business Name): ABIGAIL CELESTE PETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 HIGHWAY 45 N
COLUMBUS MS
39705-1950
US

IV. Provider business mailing address

1611 CHICKASAW DR
COLUMBUS MS
39705-1428
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-1766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-102527
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: