Healthcare Provider Details

I. General information

NPI: 1033731492
Provider Name (Legal Business Name): JAMIE HINES MCKINLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE DEPT 119-A
JACKSON MS
39216-5116
US

IV. Provider business mailing address

1500 E WOODROW WILSON AVE DEPT 119-A
JACKSON MS
39216-5116
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-1297
  • Fax: 601-368-4006
Mailing address:
  • Phone: 601-364-1297
  • Fax: 601-368-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-09473
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: