Healthcare Provider Details

I. General information

NPI: 1619572187
Provider Name (Legal Business Name): PAULINE NJITI PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E FIFTEENTH ST
YAZOO CITY MS
39194-7625
US

IV. Provider business mailing address

800 E FIFTEENTH ST
YAZOO CITY MS
39194-7625
US

V. Phone/Fax

Practice location:
  • Phone: 662-751-8580
  • Fax: 662-751-8580
Mailing address:
  • Phone: 662-751-8580
  • Fax: 662-751-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT-16503
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: