Provider Demographics
NPI:1174617005
Name:WHITE, JENNIFER JUSTICE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUSTICE
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 1:810 MATNEY RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-8532
Mailing Address - Country:US
Mailing Address - Phone:276-964-6668
Mailing Address - Fax:276-963-9395
Practice Address - Street 1:810 MATNEY RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-8532
Practice Address - Country:US
Practice Address - Phone:276-964-6668
Practice Address - Fax:276-963-9395
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist