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General NPI Number Information
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NPI Number | 1124630694
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Entity Type | Individual
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Provider Name | JENNA SEWELL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 400 VETERANS AVE
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City | BILOXI
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State | MS
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Zip | 39531-2410
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Country | US
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Telephone | 228-523-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 VETERANS AVENUE
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City | BILOXI
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State | MS
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Zip | 39531
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Country | US
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Telephone | 504-258-8902
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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 | PST.023479
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PST.023479
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License Number State | LA
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