Healthcare Provider Details

I. General information

NPI: 1144903949
Provider Name (Legal Business Name): KATHRYN WHITAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 PLANK RD
SAINT JOSEPH LA
71366-6616
US

IV. Provider business mailing address

2301 LANIER DR
WINNSBORO LA
71295-3307
US

V. Phone/Fax

Practice location:
  • Phone: 318-766-4563
  • Fax:
Mailing address:
  • Phone: 318-347-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.024910
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: