Provider Demographics
NPI:1316536121
Name:HUTTO, WARREN EDMOND (R PH)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:EDMOND
Last Name:HUTTO
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 WAYNE STREET
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367
Mailing Address - Country:US
Mailing Address - Phone:601-735-4444
Mailing Address - Fax:601-735-5885
Practice Address - Street 1:923 WAYNE STREET
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367
Practice Address - Country:US
Practice Address - Phone:601-735-4444
Practice Address - Fax:601-735-5885
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist