Provider Demographics
NPI:1285257022
Name:WHITE, DIRK T (RPH)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:T
Last Name:WHITE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GRANITE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9578
Mailing Address - Country:US
Mailing Address - Phone:907-738-6337
Mailing Address - Fax:907-966-3979
Practice Address - Street 1:117 GRANITE CREEK RD
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9578
Practice Address - Country:US
Practice Address - Phone:907-738-6337
Practice Address - Fax:907-966-3979
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 133NN1002X, 174H00000X, 251E00000X, 251F00000X, 251G00000X, 302F00000X, 305S00000X, 332B00000X, 332BX2000X
AKPH8111835N1003X, 207PH0002X, 208U00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies