Healthcare Provider Details

I. General information

NPI: 1679177372
Provider Name (Legal Business Name): DANISHICA PHALESSIA LAHOMA TROTTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 HIGHWAY 15 N
LAUREL MS
39440-2123
US

IV. Provider business mailing address

700 BEVERLY HILLS RD APT 712
HATTIESBURG MS
39401-4551
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-4670
  • Fax:
Mailing address:
  • Phone: 601-433-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-16209
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: