MEDICARE: MR. BRADLEY PAUL WHITE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-3-21701	OH

General Provider Information

NPI Number	:	1366450702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY PAUL WHITE RPH

Provider Business Mailing Address
First Line	:	2480 AUGUSTA DR SE
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44646-7494
Country	:	US
Telephone Number	:	330-323-8339
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 W HIGH AVE
Second Line	:
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-2005
Country	:	US
Telephone Number	:	330-339-4466
Fax Number	:	330-339-9007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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