Healthcare Provider Details

I. General information

NPI: 1629574918
Provider Name (Legal Business Name): BILLY CLIFTON OSBON JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 LAKELAND DRIVE SUITE 201
FLOWOOD MS
39232
US

IV. Provider business mailing address

2506 LAKELAND DRIVE SUITE 201
FLOWOOD MS
39232
US

V. Phone/Fax

Practice location:
  • Phone: 866-420-4041
  • Fax: 601-420-4040
Mailing address:
  • Phone: 866-420-4041
  • Fax: 601-420-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP08628
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: