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General NPI Number Information
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NPI Number | 1063218741
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Entity Type | Individual
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Provider Name | JACQUELINE WHITE PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 02/22/2025
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 4651 BABCOCK ST NE STE 5A
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City | PALM BAY
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State | FL
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Zip | 32905-2808
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Country | US
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Telephone | 321-914-0484
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Fax |
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Provider Business Mailing Address
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Address Line | 26300 ASUNCION DR
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City | PUNTA GORDA
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State | FL
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Zip | 33983-5357
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Country | US
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Telephone | 407-222-8104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 31947
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License Number State | FL
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