Provider Demographics
NPI:1144043324
Name:WHITE, RONALD CARY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CARY
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W JUNEAU ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0767
Mailing Address - Country:US
Mailing Address - Phone:918-688-6345
Mailing Address - Fax:
Practice Address - Street 1:201 N SCRAPER ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-3209
Practice Address - Country:US
Practice Address - Phone:918-256-2541
Practice Address - Fax:918-256-5295
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist