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NPI Code Detail

MEDICARE: MRS. LAUREN SMYTHE BLOODWORTH PHARM.D.

MEDICARE: MRS. LAUREN SMYTHE BLOODWORTH PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistE-09349MMS

General Provider Information

NPI Number : 1356439046
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREN SMYTHE BLOODWORTH PHARM.D.
Provider Business Mailing Address
First Line : 108 VICK DR
Second Line :
City : MADISON
State : MS
Zip : 39110-7699
Country : US
Telephone Number : 601-497-3049
Fax Number : 601-984-2751
Provider Business Practice Location Address
First Line : 2500 N STATE ST
Second Line :
City : JACKSON
State : MS
Zip : 39216-4500
Country : US
Telephone Number : 601-984-2061
Fax Number : 601-815-4858
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/08/2007

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