Provider Demographics
NPI:1699976472
Name:WHITE, DIANNE W (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:W
Last Name:WHITE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 MYRTLE ROAD
Mailing Address - Street 2:POBOX 96
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292
Mailing Address - Country:US
Mailing Address - Phone:360-629-1729
Mailing Address - Fax:
Practice Address - Street 1:8635 MYRTLE RD.
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292
Practice Address - Country:US
Practice Address - Phone:360-629-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist