Healthcare Provider Details

I. General information

NPI: 1578679569
Provider Name (Legal Business Name): RAINA L. WHITE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 SW HIGGINS AVE
MISSOULA MT
59803-3606
US

IV. Provider business mailing address

918 SW HIGGINS AVE
MISSOULA MT
59803-3606
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-4125
  • Fax: 406-549-8310
Mailing address:
  • Phone: 406-549-4125
  • Fax: 406-549-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3997
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: