=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952626491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL FORESTER WHALE RPH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2010
-----------------------------------------------------
Last Update Date | 03/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13105 W COLONIAL DR
-----------------------------------------------------
City | WINTER GARDEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34787-3922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-656-2604
-----------------------------------------------------
Fax | 407-656-1963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 902
-----------------------------------------------------
City | GOTHA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34734-0902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-341-8348
-----------------------------------------------------
Fax | 407-299-5814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS32412
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------