Provider Demographics
NPI:1013254150
Name:WHITE, CHRISTOPHER JOHN
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 KEITH BRIDGE RD
Mailing Address - Street 2:PUBLIX PHARMACY
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5568
Mailing Address - Country:US
Mailing Address - Phone:678-455-0630
Mailing Address - Fax:678-455-0730
Practice Address - Street 1:3480 KEITH BRIDGE RD
Practice Address - Street 2:PUBLIX PHARMACY
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5568
Practice Address - Country:US
Practice Address - Phone:678-455-0630
Practice Address - Fax:678-455-0730
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist