Provider Demographics
NPI:1508274135
Name:WHITE, DAN (RPN)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLANK ROAD CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8133
Mailing Address - Country:US
Mailing Address - Phone:636-273-1939
Mailing Address - Fax:
Practice Address - Street 1:4700 NORTH HANLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:314-475-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist