Healthcare Provider Details

I. General information

NPI: 1053927053
Provider Name (Legal Business Name): WHITE'S PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FIFTH AVE W
WIGGINS MS
39577-2204
US

IV. Provider business mailing address

301 FIFTH AVE W
WIGGINS MS
39577-2204
US

V. Phone/Fax

Practice location:
  • Phone: 16-928-4421
  • Fax: 601-928-3967
Mailing address:
  • Phone: 16-928-4421
  • Fax: 601-928-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDRA JANE WHITE
Title or Position: PHARMD/SECRETARY
Credential:
Phone: 601-928-4421