Provider Demographics
NPI:1225628183
Name:HAINES, GEORGE LAMARE (PHARMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LAMARE
Last Name:HAINES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 ROXBURY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6368
Mailing Address - Country:US
Mailing Address - Phone:601-259-8603
Mailing Address - Fax:
Practice Address - Street 1:1313 ROXBURY CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-6368
Practice Address - Country:US
Practice Address - Phone:601-259-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-16594183500000X
LAPST.024482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist