Healthcare Provider Details

I. General information

NPI: 1245787688
Provider Name (Legal Business Name): WHITE HOUSE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 FOREST AVE
SAN JOSE CA
95128-1505
US

IV. Provider business mailing address

2453 FOREST AVE
SAN JOSE CA
95128-1505
US

V. Phone/Fax

Practice location:
  • Phone: 408-296-5015
  • Fax: 408-248-2790
Mailing address:
  • Phone: 408-296-5015
  • Fax: 408-248-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY54957
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY54957
License Number StateCA

VIII. Authorized Official

Name: MR. PATRICK J D'ANGELO
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 408-296-5015