=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861092264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY WHITE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2020
-----------------------------------------------------
Last Update Date | 10/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1360 E DRAPER PKWY
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-8567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-816-9466
-----------------------------------------------------
Fax | 801-816-9468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2598 W MARTINGALE CIR
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-633-4523
-----------------------------------------------------
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 | 337971-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------