Provider Demographics
NPI:1760192520
Name:WHITE, FAWN LINETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:LINETTE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 ANDOVER AVE APT B
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1423
Mailing Address - Country:US
Mailing Address - Phone:657-253-0961
Mailing Address - Fax:
Practice Address - Street 1:750 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1914
Practice Address - Country:US
Practice Address - Phone:760-353-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist