Provider Demographics
NPI:1750739017
Name:WHITE, PAULA SUE (PHARMACY TECH)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:SUE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:TORNADO
Mailing Address - State:WV
Mailing Address - Zip Code:25202-9633
Mailing Address - Country:US
Mailing Address - Phone:304-756-3436
Mailing Address - Fax:304-720-3218
Practice Address - Street 1:169 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:TORNADO
Practice Address - State:WV
Practice Address - Zip Code:25202
Practice Address - Country:US
Practice Address - Phone:304-756-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT0000955183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician