Provider Demographics
NPI:1124393764
Name:WHITE, JERRICK (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JERRICK
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 LATTING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-7008
Mailing Address - Country:US
Mailing Address - Phone:901-861-5058
Mailing Address - Fax:
Practice Address - Street 1:1850 LATTING VALLEY RD
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-7008
Practice Address - Country:US
Practice Address - Phone:901-861-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist