Provider Demographics
NPI:1124649918
Name:MALLETT, WHITNEY ALISE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:ALISE
Last Name:MALLETT
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 1:106 BLACKBERRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-9017
Mailing Address - Country:US
Mailing Address - Phone:601-850-9192
Mailing Address - Fax:
Practice Address - Street 1:2129 GRAND AVE
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2312
Practice Address - Country:US
Practice Address - Phone:662-673-4020
Practice Address - Fax:662-673-4031
Is Sole Proprietor?:No
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14552208U00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology