Healthcare Provider Details

I. General information

NPI: 1912916149
Provider Name (Legal Business Name): TOMMY ELVIS WHITEHEAD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 HIGHWAY 72
KILLEN AL
35645-9142
US

IV. Provider business mailing address

13150 FRANKFORT RD
TUSCUMBIA AL
35674-8810
US

V. Phone/Fax

Practice location:
  • Phone: 256-757-2166
  • Fax: 256-757-9580
Mailing address:
  • Phone: 256-381-4974
  • Fax: 256-757-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7493
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: