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General NPI Number Information
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NPI Number | 1487733390
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Entity Type | Individual
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Provider Name | MRS. JEAN ROSS SHAW
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 584 E MAIN ST SUITE8-A
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City | PHILADELPHIA
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State | MS
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Zip | 39350-2342
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Country | US
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Telephone | 601-656-5477
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Fax | 601-650-9882
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Provider Business Mailing Address
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Address Line | 12401 HIGHWAY 491 S
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City | UNION
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State | MS
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Zip | 39365-8540
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Country | US
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Telephone | 601-656-5477
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Fax | 601-650-9882
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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 | N/A
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License Number State | MS
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