Healthcare Provider Details

I. General information

NPI: 1619958105
Provider Name (Legal Business Name): MARY ELIZABETH MARTINEAU WHITE R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 HIGHWAY 73
DENVER NC
28037-9186
US

IV. Provider business mailing address

3472 LAKE SHORE RD S
DENVER NC
28037-8234
US

V. Phone/Fax

Practice location:
  • Phone: 48-288-2287
  • Fax:
Mailing address:
  • Phone: 419-799-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25670
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: