Provider Demographics
NPI:1073811816
Name:WHITE, WILLIAM JAMES
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAMES
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9726
Mailing Address - Country:US
Mailing Address - Phone:910-313-2877
Mailing Address - Fax:910-313-6796
Practice Address - Street 1:6930 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9726
Practice Address - Country:US
Practice Address - Phone:910-313-2877
Practice Address - Fax:910-313-6796
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0656025Medicaid