Provider Demographics
NPI:1124109293
Name:WHITE, KELLY CHRISTINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CHRISTINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 FOXTAIL DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4034
Mailing Address - Country:US
Mailing Address - Phone:563-940-8520
Mailing Address - Fax:
Practice Address - Street 1:1590 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403
Practice Address - Country:US
Practice Address - Phone:541-346-4454
Practice Address - Fax:541-346-2749
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20454183500000X
IL051.291211183500000X
OR00163961835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist