Provider Demographics
NPI:1497363477
Name:WHITE, RANDY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
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 1:1505 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4921
Mailing Address - Country:US
Mailing Address - Phone:903-885-2639
Mailing Address - Fax:903-335-8989
Practice Address - Street 1:1505 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4921
Practice Address - Country:US
Practice Address - Phone:903-885-2639
Practice Address - Fax:903-335-8989
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist