Healthcare Provider Details

I. General information

NPI: 1184900573
Provider Name (Legal Business Name): KRISTEN MARIE WHITE PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2011
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CORTLAND ACRES LN
THOMAS WV
26292-8066
US

IV. Provider business mailing address

209 N 3RD ST
OAKLAND MD
21550-1325
US

V. Phone/Fax

Practice location:
  • Phone: 304-463-4200
  • Fax:
Mailing address:
  • Phone: 301-334-1597
  • Fax: 301-533-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0007272
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19404
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: