Healthcare Provider Details

I. General information

NPI: 1639583701
Provider Name (Legal Business Name): DAVID CASEY WHITTAKER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BISHOP ST
CORBIN KY
40701-1702
US

IV. Provider business mailing address

121 BISHOP ST CLINIC
CORBIN KY
40701-7862
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-2124
  • Fax: 606-546-6992
Mailing address:
  • Phone: 65-282-1246
  • Fax: 606-546-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number015771
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: