Provider Demographics
NPI:1629377494
Name:LUNSFORD, WEATHERBY
Entity Type:Individual
Prefix:
First Name:WEATHERBY
Middle Name:
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 BERRYTOWN RD SE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-9006
Mailing Address - Country:US
Mailing Address - Phone:601-383-0477
Mailing Address - Fax:
Practice Address - Street 1:208 W PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-5524
Practice Address - Country:US
Practice Address - Phone:601-684-3401
Practice Address - Fax:601-957-2956
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist