Provider Demographics
NPI:1851996342
Name:JEFFERSON, LARHONDA (PHARM D)
Entity Type:Individual
Prefix:
First Name:LARHONDA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25820 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-2763
Mailing Address - Country:US
Mailing Address - Phone:662-494-4990
Mailing Address - Fax:
Practice Address - Street 1:25820 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-2763
Practice Address - Country:US
Practice Address - Phone:662-494-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-12669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist