Provider Demographics
NPI:1497844716
Name:WHITE, PAMELA DENISE (RPH)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DENISE
Last Name:WHITE
Suffix:
Gender:F
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-0061
Mailing Address - Country:US
Mailing Address - Phone:504-452-6754
Mailing Address - Fax:985-340-3834
Practice Address - Street 1:1131 SOUTH MORRISON AVENUE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-340-2101
Practice Address - Fax:985-340-3834
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist