Healthcare Provider Details

I. General information

NPI: 1083067417
Provider Name (Legal Business Name): WHITNEY MACNAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 S SANTIAM HWY
LEBANON OR
97355-3737
US

IV. Provider business mailing address

3290 S SANTIAM HWY
LEBANON OR
97355-3737
US

V. Phone/Fax

Practice location:
  • Phone: 541-258-7440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH0015111
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH0015111
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: