Healthcare Provider Details

I. General information

NPI: 1891741690
Provider Name (Legal Business Name): WHITE OAK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8465 STATE ROUTE 339
VINCENT OH
45784-5647
US

IV. Provider business mailing address

PO BOX 337
VINCENT OH
45784
US

V. Phone/Fax

Practice location:
  • Phone: 740-678-2384
  • Fax: 740-678-8696
Mailing address:
  • Phone: 740-678-2384
  • Fax: 740-678-8696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALPESH PATEL
Title or Position: OWNER
Credential:
Phone: 813-304-2221