Healthcare Provider Details

I. General information

NPI: 1285554261
Provider Name (Legal Business Name): MISTY BALLARD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 HIGHWAY 72 E
CORINTH MS
38834-6709
US

IV. Provider business mailing address

2026 HIGHWAY 72 E
CORINTH MS
38834-6709
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-4066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-09801
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: