Provider Demographics
NPI:1366450702
Name:WHITE, BRADLEY PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:PAUL
Last Name:WHITE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 AUGUSTA DR SE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-7494
Mailing Address - Country:US
Mailing Address - Phone:330-323-8339
Mailing Address - Fax:
Practice Address - Street 1:551 W HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2005
Practice Address - Country:US
Practice Address - Phone:330-339-4466
Practice Address - Fax:330-339-9007
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-21701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist