Provider Demographics
NPI:1598074726
Name:WHITE, SANDRA BROWN (RPH)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:BROWN
Last Name:WHITE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:JANE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:114 E LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3662
Mailing Address - Country:US
Mailing Address - Phone:336-786-2177
Mailing Address - Fax:336-786-1556
Practice Address - Street 1:114 E LEBANON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3662
Practice Address - Country:US
Practice Address - Phone:336-786-2177
Practice Address - Fax:336-786-1556
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC0865492Medicaid