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General NPI Number Information
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NPI Number | 1750982245
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Entity Type | Individual
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Provider Name | STEPHANIE DIANE WHITAKER
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 5110 COLLEGE AVE
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City | SNYDER
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State | TX
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Zip | 79549-6112
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Country | US
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Telephone | 325-573-1965
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Fax | 325-573-3312
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Provider Business Mailing Address
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Address Line | 3797 HIGHLAND DR
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City | SNYDER
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State | TX
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Zip | 79549-5317
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Country | US
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Telephone | 940-210-0245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 61989
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License Number State | TX
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