Provider Demographics
NPI:1073598553
Name:WHITE, SCOTT ERIC (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ERIC
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 1:3903 207TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-6949
Mailing Address - Country:US
Mailing Address - Phone:206-909-8017
Mailing Address - Fax:
Practice Address - Street 1:1115 13TH ST
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2012
Practice Address - Country:US
Practice Address - Phone:360-568-0548
Practice Address - Fax:360-568-5151
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist