Healthcare Provider Details

I. General information

NPI: 1689773566
Provider Name (Legal Business Name): ISABEL PRINCE LOCKHART RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST WOODROW WILSON BLVD
JACKSON MS
39216-5199
US

IV. Provider business mailing address

129 PARKSIDE DR.
BRANDON MS
39042-4214
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-364-1578
Mailing address:
  • Phone: 601-825-6093
  • Fax: 601-364-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE08965
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: