Provider Demographics
NPI:1255703591
Name:WHITE, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11140 WESTERN TPKE
Mailing Address - Street 2:
Mailing Address - City:ESPERANCE
Mailing Address - State:NY
Mailing Address - Zip Code:12066-3010
Mailing Address - Country:US
Mailing Address - Phone:518-875-9414
Mailing Address - Fax:518-875-9417
Practice Address - Street 1:11140 WESTERN TPKE
Practice Address - Street 2:
Practice Address - City:ESPERANCE
Practice Address - State:NY
Practice Address - Zip Code:12066-3010
Practice Address - Country:US
Practice Address - Phone:518-875-9414
Practice Address - Fax:518-875-9417
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067402183500000X
CA66465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist