Provider Demographics
NPI:1255887022
Name:WHITE, COURTNEY (PHARMD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
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 1:5851 CARDINAL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22842-9433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 STATLER BLVD, STATLER SQUARE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-885-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist