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General NPI Number Information
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NPI Number | 1649312778
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Entity Type | Organization
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Legal Business Name | DAVID R. WHITLEY
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 501 N MAIN ST
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-1636
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Country | US
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Telephone | 270-726-9592
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Fax | 270-726-9881
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Provider Business Mailing Address
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Address Line | 501 N MAIN ST
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-1636
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Country | US
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Telephone | 270-726-9592
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Fax | 270-726-9881
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Authorized Official
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Title or Position | OWNER , R.PH.
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Name | DAVID RANDALL WHITLEY
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Credential |
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Telephone | 270-726-9592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P01622
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License Number State | KY
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