=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902845381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITFORD PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 327 MAIN ST
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53530-1425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-776-4481
-----------------------------------------------------
Fax | 608-776-2341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 327 MAIN ST
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53530-1425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-776-4481
-----------------------------------------------------
Fax | 608-776-2341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. WILLIAM J WHITFORD
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 608-776-4481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 8099
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------