Provider Demographics
NPI:1467758169
Name:CAVINESS, JEANNIE K (RPH)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:K
Last Name:CAVINESS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-1228
Mailing Address - Country:US
Mailing Address - Phone:662-628-5811
Mailing Address - Fax:662-628-1247
Practice Address - Street 1:599 W VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-5501
Practice Address - Country:US
Practice Address - Phone:662-628-5811
Practice Address - Fax:662-628-1247
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist