Provider Demographics
NPI:1518018290
Name:WHITES PHARMACY OF DALTON LLC
Entity Type:Organization
Organization Name:WHITES PHARMACY OF DALTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-259-9707
Mailing Address - Street 1:2955B CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8004
Mailing Address - Country:US
Mailing Address - Phone:706-259-9707
Mailing Address - Fax:706-259-2278
Practice Address - Street 1:2955B CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8004
Practice Address - Country:US
Practice Address - Phone:706-259-9707
Practice Address - Fax:706-259-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0072003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2017346OtherPK
GA00434552AMedicaid
1135854OtherNABP NUMBER