Provider Demographics
NPI:1255478202
Name:WHITE, JOHN ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALLEN
Last Name:WHITE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:224 E WOODGLEN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5304
Mailing Address - Country:US
Mailing Address - Phone:864-574-1270
Mailing Address - Fax:864-455-1340
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:DEPT OF HARMACY, GREENVILE MEM MED CENTER
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:865-455-1363
Practice Address - Fax:864-455-1340
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist