Provider Demographics
NPI:1730463126
Name:WHITE, DOREEN M (RPH)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WOODSTOCK AVE.
Mailing Address - Street 2:WALGREENS
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-9142
Mailing Address - Country:US
Mailing Address - Phone:802-775-1932
Mailing Address - Fax:
Practice Address - Street 1:10 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3514
Practice Address - Country:US
Practice Address - Phone:802-775-1932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033-2465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist