Provider Demographics
NPI:1013023126
Name:WHITE, JOHN ROGER (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROGER
Last Name:WHITE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 LA COSTA ST
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6424
Mailing Address - Country:US
Mailing Address - Phone:775-626-0284
Mailing Address - Fax:
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:775-328-1840
Practice Address - Fax:775-328-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist