Provider Demographics
NPI:1629235742
Name:WHITE, ADAM D (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 KELLOGG WOODS DR SE APT 102
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49548-0808
Mailing Address - Country:US
Mailing Address - Phone:989-277-6358
Mailing Address - Fax:
Practice Address - Street 1:431 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1103
Practice Address - Country:US
Practice Address - Phone:616-527-4300
Practice Address - Fax:616-527-0019
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist