Provider Demographics
NPI:1063013365
Name:WHITE, DEREK (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
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:WALMART PHARMACY
Mailing Address - Street 2:1123 HIGHWAY 79-167 BYPASS
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742
Mailing Address - Country:US
Mailing Address - Phone:870-352-8034
Mailing Address - Fax:870-352-8337
Practice Address - Street 1:WALMART PHARMACY
Practice Address - Street 2:1123 HIGHWAY 79-167 BYPASS
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742
Practice Address - Country:US
Practice Address - Phone:870-352-8034
Practice Address - Fax:870-352-8337
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist