Healthcare Provider Details

I. General information

NPI: 1720338197
Provider Name (Legal Business Name): TOM KIM WHITE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 04/20/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W CHURCH ST
CARLSBAD NM
88220-6300
US

IV. Provider business mailing address

202 W CHURCH ST
CARLSBAD NM
88220-6300
US

V. Phone/Fax

Practice location:
  • Phone: 575-887-5085
  • Fax: 575-887-8300
Mailing address:
  • Phone: 575-887-5085
  • Fax: 575-887-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00004960
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: