Healthcare Provider Details

I. General information

NPI: 1881099679
Provider Name (Legal Business Name): MICHAEL WHITT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREAT TEAYS BLVD
SCOTT DEPOT WV
25560
US

IV. Provider business mailing address

101 GREAT TEAYS BLVD
SCOTT DEPOT WV
25560
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-8952
  • Fax: 304-757-5460
Mailing address:
  • Phone: 304-757-8952
  • Fax: 304-757-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0008957
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP0008957
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: