Healthcare Provider Details

I. General information

NPI: 1336926617
Provider Name (Legal Business Name): MIKINNA WHITE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E COUNTY LINE RD
GREENWOOD IN
46143-1079
US

IV. Provider business mailing address

333 E COUNTY LINE RD
GREENWOOD IN
46143-1079
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-7333
  • Fax:
Mailing address:
  • Phone: 317-887-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030360A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: