Provider Demographics
NPI:1285607168
Name:WHITE, ROY (RPH)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:
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 1:5022 MOOR DALE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6840
Mailing Address - Country:US
Mailing Address - Phone:801-278-1070
Mailing Address - Fax:
Practice Address - Street 1:3795 KIESEL AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-1601
Practice Address - Country:US
Practice Address - Phone:801-394-9414
Practice Address - Fax:801-394-6113
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140145-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist