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General NPI Number Information
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NPI Number | 1083218747
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Entity Type | Individual
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Provider Name | KEVIN WHITE
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Gender | Male
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 700 BROAD ST
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City | RIVERTON
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State | NJ
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Zip | 08077-1145
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Country | US
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Telephone | 856-829-1187
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Fax |
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Provider Business Mailing Address
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Address Line | 716 CORNWALLIS DR
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-3219
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Country | US
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Telephone | 609-234-2551
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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 | 28RI03371100
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License Number State | NJ
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