Healthcare Provider Details

I. General information

NPI: 1164966859
Provider Name (Legal Business Name): WHITAKER DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CAMDEN BYP
CAMDEN AL
36726-1770
US

IV. Provider business mailing address

20 CAMDEN BYP
CAMDEN AL
36726-1770
US

V. Phone/Fax

Practice location:
  • Phone: 334-682-9990
  • Fax: 334-682-9991
Mailing address:
  • Phone: 334-682-9990
  • Fax: 334-682-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114682
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES WHITAKER
Title or Position: PHARMACIST
Credential:
Phone: 334-456-1589