Provider Demographics
NPI:1366041501
Name:WHITE NILE
Entity Type:Organization
Organization Name:WHITE NILE
Other - Org Name:BRISTOL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAEID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:484-620-3937
Mailing Address - Street 1:11034 N 28TH DR UNIT 308
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4380
Mailing Address - Country:US
Mailing Address - Phone:484-620-3937
Mailing Address - Fax:
Practice Address - Street 1:4338 W THOMAS RD UNIT E5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3878
Practice Address - Country:US
Practice Address - Phone:484-620-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZY008419OtherSTATE BOARD OF PHARMACY