Provider Demographics
NPI:1487171971
Name:LITTLE, GINGER
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WATSON DR
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-8390
Mailing Address - Country:US
Mailing Address - Phone:662-282-4245
Mailing Address - Fax:
Practice Address - Street 1:67 WATSON DR
Practice Address - Street 2:
Practice Address - City:MANTACHIE
Practice Address - State:MS
Practice Address - Zip Code:38855-8390
Practice Address - Country:US
Practice Address - Phone:662-282-4245
Practice Address - Fax:662-282-4027
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist