Provider Demographics
NPI:1356566681
Name:WHITE, JOE BRIAN (R PH)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:BRIAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 CEYLON CIR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1306
Mailing Address - Country:US
Mailing Address - Phone:937-429-3861
Mailing Address - Fax:
Practice Address - Street 1:1072 CEYLON CIR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45430-1306
Practice Address - Country:US
Practice Address - Phone:937-429-3861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-13571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist