Provider Demographics
NPI:1760789887
Name:LITTLE, JACKIE BADGER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:BADGER
Last Name:LITTLE
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 1:2 CRESCENT DR.
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-1701
Mailing Address - Country:US
Mailing Address - Phone:336-246-2790
Mailing Address - Fax:336-246-2023
Practice Address - Street 1:2 CRESCENT DR.
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-1701
Practice Address - Country:US
Practice Address - Phone:336-246-2790
Practice Address - Fax:336-246-2023
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist