Provider Demographics
NPI:1235338690
Name:WHITE CROSS PHARMACY
Entity Type:Organization
Organization Name:WHITE CROSS PHARMACY
Other - Org Name:WHITE CROSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MART
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:888-228-0555
Mailing Address - Street 1:1412 W. GLENOAKS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1980
Mailing Address - Country:US
Mailing Address - Phone:888-228-0555
Mailing Address - Fax:818-986-1599
Practice Address - Street 1:1412 W GLENOAKS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1980
Practice Address - Country:US
Practice Address - Phone:888-228-0555
Practice Address - Fax:818-986-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 41289333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 41289OtherPHARMACY