MEDICARE: ROBERT ALDEN WHYTE 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	112974-4	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	112974	OTHER	MN	STATE LICENSE (PHARMACIST)

General Provider Information

NPI Number	:	1730182460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ALDEN WHYTE R.PH.

Provider Business Mailing Address
First Line	:	1357 WELLESLEY AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2418
Country	:	US
Telephone Number	:	612-234-2559
Fax Number	:	651-690-4838

Provider Business Practice Location Address
First Line	:	1357 WELLESLEY AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2418
Country	:	US
Telephone Number	:	612-234-2559
Fax Number	:	651-690-4838

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/15/2009

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