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General NPI Number Information
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NPI Number | 1063140564
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Entity Type | Individual
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Provider Name | KAJIJO M GUYA
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Gender | Male
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 55 GOODMAN RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9447
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Country | US
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Telephone | 662-349-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 TUSCUMBIA RD
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City | COLLIERVILLE
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State | TN
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Zip | 38017-3417
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | T-12688
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License Number State | MS
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