Provider Demographics
NPI:1780807982
Name:WHITE, JOSEPH R (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:WHITE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:J
Other - Middle Name:RANDALL
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1120 HAVERHILL TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6127
Mailing Address - Country:US
Mailing Address - Phone:678-344-6135
Mailing Address - Fax:
Practice Address - Street 1:1120 HAVERHILL TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6127
Practice Address - Country:US
Practice Address - Phone:678-344-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12960133N00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered183500000XPharmacy Service ProvidersPharmacist