Healthcare Provider Details

I. General information

NPI: 1891835757
Provider Name (Legal Business Name): JIMMIE LEE WHISENHUNT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MAIN ST
HOOKS TX
75561-5155
US

IV. Provider business mailing address

PO BOX 129
HOOKS TX
75561-0129
US

V. Phone/Fax

Practice location:
  • Phone: 903-547-2782
  • Fax: 903-547-3266
Mailing address:
  • Phone:
  • Fax:

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 Number1177
License Number StateTX

VIII. Authorized Official

Name: JIM WHISENHUNT
Title or Position: OWNER AND CEO
Credential:
Phone: 903-547-2782