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General NPI Number Information
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NPI Number | 1790303394
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Entity Type | Organization
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Legal Business Name | WHITE TIP PHARMACY LLC
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 411 S FEDERAL HWY STE D
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-4170
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Country | US
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Telephone | 954-531-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 411 S FEDERAL HWY STE D
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-4170
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IVAN ASHLEY FERGUSON
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Credential |
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Telephone | 954-531-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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