Provider Demographics
NPI:1467835439
Name:WHITE, GARRETT M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4227
Mailing Address - Country:US
Mailing Address - Phone:304-296-2547
Mailing Address - Fax:
Practice Address - Street 1:405 FAIRMONT RD
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-4227
Practice Address - Country:US
Practice Address - Phone:304-296-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist