MEDICARE: MS. ANGELA WHITNEY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	131503-1701	UT

General Provider Information

NPI Number	:	1275620882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA WHITNEY RPH

Provider Business Mailing Address
First Line	:	12091 KATELYN PARK CT
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8332
Country	:	US
Telephone Number	:	801-816-1497
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 S STATE ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1401
Country	:	US
Telephone Number	:	801-442-3244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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