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NPI Code Detail

MEDICARE: GENEVA WHITE RPH

MEDICARE: GENEVA 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
1183500000XPharmacistPS32644FL

General Provider Information

NPI Number : 1629307236
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENEVA WHITE RPH
Provider Business Mailing Address
First Line : 4501 HOFFNER AVE
Second Line :
City : ORLANDO
State : FL
Zip : 32812-2305
Country : US
Telephone Number : 407-850-2373
Fax Number :
Provider Business Practice Location Address
First Line : 4501 HOFFNER AVE
Second Line :
City : ORLANDO
State : FL
Zip : 32812-2305
Country : US
Telephone Number : 407-850-2373
Fax Number : 407-850-9526
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2009
Last Update Date : 12/09/2009

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