Individual
MARK JASON WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
289 IRELAND AVE, FORT KNOX, KY 40121-5111
(502) 624-9731
(502) 624-0333
Mailing address
289 IRELAND AVE, FORT KNOX, KY 40121-5111
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
011111
KY
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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