=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538637939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER WHITE PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2018
-----------------------------------------------------
Last Update Date | 11/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 N MAIN ST
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-5044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-472-7450
-----------------------------------------------------
Fax | 573-472-7458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 WOODHAVEN ST
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-9447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-934-2668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 2010027166
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------