Healthcare Provider Details

I. General information

NPI: 1255326930
Provider Name (Legal Business Name): GINA ELIZABETH WHITE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE PHARMACY DEPARTMENT
MIAMI FL
33136-1005
US

IV. Provider business mailing address

3519 MARLER AVE
MIAMI FL
33133-5721
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8906
  • Fax: 305-585-1993
Mailing address:
  • Phone: 305-443-3485
  • Fax: 305-444-9264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number25096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: