Provider Demographics
NPI:1013977792
Name:WHITE, TODD RUSSELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:RUSSELL
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 HAMMOCK OAK LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6455
Mailing Address - Country:US
Mailing Address - Phone:859-245-8083
Mailing Address - Fax:
Practice Address - Street 1:976 HAMMOCK OAK LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6455
Practice Address - Country:US
Practice Address - Phone:859-245-8083
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist