MEDICARE: MARY ELIZABETH MARTINEAU WHITE R.PH

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	25670	NC

General Provider Information

NPI Number	:	1619958105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH MARTINEAU WHITE R.PH

Provider Business Mailing Address
First Line	:	3472 LAKE SHORE RD S
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-8234
Country	:	US
Telephone Number	:	419-799-9301
Fax Number	:

Provider Business Practice Location Address
First Line	:	7131 HIGHWAY 73
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-9186
Country	:	US
Telephone Number	:	48-288-2287
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	11/14/2024

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