Healthcare Provider Details

I. General information

NPI: 1093628612
Provider Name (Legal Business Name): JAZMINE HOLLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 HIGHWAY 61 N
NATCHEZ MS
39120-8440
US

IV. Provider business mailing address

26 E WOODLAWN AVE
NATCHEZ MS
39120-2859
US

V. Phone/Fax

Practice location:
  • Phone: 601-446-7167
  • Fax:
Mailing address:
  • Phone: 601-446-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026309
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT-102592
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: