Provider Demographics
NPI:1922690221
Name:PAULEY, JAMIE REBECCA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:REBECCA
Last Name:PAULEY
Suffix:
Gender:F
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:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-8133
Mailing Address - Country:US
Mailing Address - Phone:276-239-0141
Mailing Address - Fax:
Practice Address - Street 1:289 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2331
Practice Address - Country:US
Practice Address - Phone:276-228-2178
Practice Address - Fax:276-228-3095
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist