Provider Demographics
NPI:1679842686
Name:LITTLE, B E (R PH)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:E
Last Name:LITTLE
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 1:3189 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-3503
Mailing Address - Country:US
Mailing Address - Phone:601-664-0641
Mailing Address - Fax:601-664-0917
Practice Address - Street 1:3189 HWY 80 EAST
Practice Address - Street 2:WALGREENS
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3503
Practice Address - Country:US
Practice Address - Phone:601-664-0641
Practice Address - Fax:601-664-0917
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-6283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist