=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326165861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN MICHELE WHETSTINE RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 2ND AVE
-----------------------------------------------------
City | MUSCATINE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52761-5260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-264-5810
-----------------------------------------------------
Fax | 563-264-5811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 CANON AVE
-----------------------------------------------------
City | MUSCATINE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52761-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-506-2137
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 18667
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------