Provider Demographics
NPI:1124430046
Name:WHITE, DOUGLAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 COOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8744
Mailing Address - Country:US
Mailing Address - Phone:989-343-9761
Mailing Address - Fax:989-343-9763
Practice Address - Street 1:2750 COOK RD
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8744
Practice Address - Country:US
Practice Address - Phone:989-343-9761
Practice Address - Fax:989-343-9763
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist