Provider Demographics
NPI:1861934853
Name:WHITE, ALYSSA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 HOFFMEISTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELEN
Mailing Address - State:MI
Mailing Address - Zip Code:48656-9545
Mailing Address - Country:US
Mailing Address - Phone:419-787-3177
Mailing Address - Fax:
Practice Address - Street 1:2010 N SAINT HELEN RD
Practice Address - Street 2:
Practice Address - City:SAINT HELEN
Practice Address - State:MI
Practice Address - Zip Code:48656-8555
Practice Address - Country:US
Practice Address - Phone:989-389-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1871992271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty