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NPI Code Detail

MEDICARE: DR. EVAN ANDREW WHITE PHARMD

MEDICARE: DR. EVAN ANDREW WHITE PHARMD
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
1183500000XPharmacist0202209965VA
2183500000XPharmacistRP446656PA
3183500000XPharmacist28RI03481600NJ

General Provider Information

NPI Number : 1598018376
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EVAN ANDREW WHITE PHARMD
Provider Business Mailing Address
First Line : 1440 MOUNT VERNON ST APT 102
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-2946
Country : US
Telephone Number : 757-572-2092
Fax Number :
Provider Business Practice Location Address
First Line : 1809 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-3119
Country : US
Telephone Number : 215-426-0956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2012
Last Update Date : 10/18/2012

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