Healthcare Provider Details

I. General information

NPI: 1609268978
Provider Name (Legal Business Name): MARY JEAN SEWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

4701 LAKELAND DR APT. 18H
FLOWOOD MS
39232-9506
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6887
  • Fax:
Mailing address:
  • Phone: 256-520-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-13563
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: