Healthcare Provider Details

I. General information

NPI: 1083522064
Provider Name (Legal Business Name): DESTINY GREAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 HIGHWAY 80 W RM 68
JACKSON MS
39209-7201
US

IV. Provider business mailing address

3450 HIGHWAY 80 W RM 68
JACKSON MS
39209-7201
US

V. Phone/Fax

Practice location:
  • Phone: 601-824-1667
  • Fax: 601-825-6347
Mailing address:
  • Phone: 601-824-1667
  • Fax: 601-825-6347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-101411
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: