Provider Demographics
NPI:1962656595
Name:WHITE, JEANNA (CPHT)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HUNT RD
Mailing Address - Street 2:#A
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-2027
Mailing Address - Country:US
Mailing Address - Phone:978-703-1158
Mailing Address - Fax:
Practice Address - Street 1:9 HUNT RD
Practice Address - Street 2:#A
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-2027
Practice Address - Country:US
Practice Address - Phone:978-703-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1020OtherCERTIFIED PHARMACY TECHNICIAN