Provider Demographics
NPI:1194857094
Name:WHITE, JAMES R
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
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:PO BOX 129
Mailing Address - Street 2:224 W KIMBALL ST
Mailing Address - City:PARKER
Mailing Address - State:SD
Mailing Address - Zip Code:57053-0129
Mailing Address - Country:US
Mailing Address - Phone:605-297-3487
Mailing Address - Fax:
Practice Address - Street 1:27600 SD HIGHWAY 19
Practice Address - Street 2:PARKER PLAZA
Practice Address - City:PARKER
Practice Address - State:SD
Practice Address - Zip Code:57053-0519
Practice Address - Country:US
Practice Address - Phone:605-297-3235
Practice Address - Fax:605-297-5594
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist