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NPI Code Detail

MEDICARE: DR. BRANDON C WHITE PHARM. D.

MEDICARE: DR. BRANDON C WHITE PHARM. D.
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
1183500000XPharmacistPD11723AR

General Provider Information

NPI Number : 1295168078
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDON C WHITE PHARM. D.
Provider Business Mailing Address
First Line : 3605 E JOHNSON AVE
Second Line :
City : JONESBORO
State : AR
Zip : 72401-1808
Country : US
Telephone Number : 870-336-8310
Fax Number : 870-336-1949
Provider Business Practice Location Address
First Line : 900 W KINGSHIGHWAY
Second Line :
City : PARAGOULD
State : AR
Zip : 72450-5942
Country : US
Telephone Number : 870-239-7865
Fax Number : 870-239-7431
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2013
Last Update Date : 08/19/2022

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