Provider Demographics
NPI:1447847058
Name:WHITE, AMY M
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
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 1:3068 TRENWEST DR STE 5
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3222
Mailing Address - Country:US
Mailing Address - Phone:336-930-1729
Mailing Address - Fax:336-930-1728
Practice Address - Street 1:3068 TRENWEST DR STE 5
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3222
Practice Address - Country:US
Practice Address - Phone:336-930-1729
Practice Address - Fax:336-930-1728
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist