Organization
M WHITE HOLDINGS LLC
Active
Other names
COLLIERS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WHITE RPH (PRESIDENT)
(770) 455-4433
Entity
Organization
Contact information
Practice address
5705 BUFORD HWY NE, DORAVILLE, GA 30340-1206
(770) 455-4433
(770) 454-9144
Mailing address
PO BOX 620679, DORAVILLE, GA 30362-2679
(770) 145-4433
(770) 454-9144
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE004985
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119666A
—
GA
05
—
00119666B
—
GA
01
—
2013845
PK
—
Enumeration date
05/03/2006
Last updated
04/14/2017
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