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General NPI Number Information
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NPI Number | 1801192257
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Entity Type | Individual
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Provider Name | LAURA JO GARDNER PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 41 S CENTER ST
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City | POTTS CAMP
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State | MS
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Zip | 38659-9531
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Country | US
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Telephone | 662-333-7782
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Fax |
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Provider Business Mailing Address
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Address Line | 525 HIGHWAY 30 W
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City | BALDWYN
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State | MS
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Zip | 38824-9051
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Country | US
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Telephone | 662-365-5534
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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 | E09336
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License Number State | MS
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