Provider Demographics
NPI:1629630645
Name:WHITE, PAUL LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LEE
Last Name:WHITE
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 1:715 GILLESPIE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1712
Mailing Address - Country:US
Mailing Address - Phone:662-610-8611
Mailing Address - Fax:
Practice Address - Street 1:238 S PEARSON RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-5637
Practice Address - Country:US
Practice Address - Phone:601-914-4848
Practice Address - Fax:601-292-7700
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-16143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist