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General NPI Number Information
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NPI Number | 1629315619
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Entity Type | Individual
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Provider Name | BENJAMIN THOMAS WHITE RPH, PHC
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Gender | Male
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 8225 4TH ST NW
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City | LOS RANCHOS
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State | NM
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Zip | 87114
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Country | US
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Telephone | 505-717-2342
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Fax | 505-492-2549
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Provider Business Mailing Address
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Address Line | 8225 4TH ST NW
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City | LOS RANCHOS
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State | NM
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Zip | 87114-1014
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Country | US
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Telephone | 505-717-2342
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Fax | 505-492-2549
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PC00000204
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License Number State | NM
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