Healthcare Provider Details

I. General information

NPI: 1497358352
Provider Name (Legal Business Name): MICKEY WHITE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 DANNAHER DR
POWELL TN
37849-4029
US

IV. Provider business mailing address

8111 ZENITH LN
POWELL TN
37849-5018
US

V. Phone/Fax

Practice location:
  • Phone: 855-836-6682
  • Fax:
Mailing address:
  • Phone: 423-608-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36601
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: