Healthcare Provider Details

I. General information

NPI: 1114709862
Provider Name (Legal Business Name): JADA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 I 55 N
JACKSON MS
39211-5401
US

IV. Provider business mailing address

4910 I 55 N
JACKSON MS
39211-5401
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-1141
  • Fax:
Mailing address:
  • Phone: 601-366-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-101373
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47126
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: