Provider Demographics
NPI:1558656603
Name:WHITE, PATRICIA D
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TOPSHAM FAIR MALL RD
Mailing Address - Street 2:T2130
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1741
Mailing Address - Country:US
Mailing Address - Phone:207-504-5051
Mailing Address - Fax:207-504-5051
Practice Address - Street 1:125 TOPSHAM FAIR MALL RD
Practice Address - Street 2:T2130
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1741
Practice Address - Country:US
Practice Address - Phone:207-504-5051
Practice Address - Fax:207-504-5051
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist