Provider Demographics
NPI:1568145852
Name:HOPSON, KALLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KALLIE
Middle Name:
Last Name:HOPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-0656
Mailing Address - Country:US
Mailing Address - Phone:662-983-4071
Mailing Address - Fax:662-983-4072
Practice Address - Street 1:203 N NEWBURGER AVE
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-9430
Practice Address - Country:US
Practice Address - Phone:662-983-4071
Practice Address - Fax:662-983-4072
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist