Provider Demographics
NPI:1689980336
Name:WHITE, ROBERT (RPH, CDOE)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:RPH, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SLATER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-3214
Mailing Address - Country:US
Mailing Address - Phone:401-487-0765
Mailing Address - Fax:
Practice Address - Street 1:178 SLATER PARK AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-3214
Practice Address - Country:US
Practice Address - Phone:401-487-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH02557133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education