Provider Demographics
NPI:1396966628
Name:STYRON, JONATHAN OVERBY (RPH)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:OVERBY
Last Name:STYRON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:128 SOGGY BOTTOM DR
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-6401
Mailing Address - Country:US
Mailing Address - Phone:601-849-4080
Mailing Address - Fax:601-849-3808
Practice Address - Street 1:376B SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3409
Practice Address - Country:US
Practice Address - Phone:601-849-3393
Practice Address - Fax:601-849-3808
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-6043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist