MEDICARE: MR. MICHAEL JOHN WHITE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S011624	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S011624	OTHER	AZ	REGISTERED PHARMACIST - IMMUNIZER

General Provider Information

NPI Number	:	1255056073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOHN WHITE RPH

Provider Business Mailing Address
First Line	:	3111 W HUNT HWY
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-9357
Country	:	US
Telephone Number	:	480-214-2561
Fax Number	:	480-214-2565

Provider Business Practice Location Address
First Line	:	3111 W HUNT HWY
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-9357
Country	:	US
Telephone Number	:	480-214-2561
Fax Number	:	480-214-2565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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Directions to “ MR. MICHAEL JOHN WHITE RPH” Practice Location

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