MEDICARE: JEFFREY DWAYNE WHITLEY 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	10168	NC

General Provider Information

NPI Number	:	1336415850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DWAYNE WHITLEY RPH

Provider Business Mailing Address
First Line	:	552 FORK RD
Second Line	:
City	:	NORWOOD
State	:	NC
Zip	:	28128-8445
Country	:	US
Telephone Number	:	704-474-4035
Fax Number	:	704-474-3551

Provider Business Practice Location Address
First Line	:	552 FORK RD
Second Line	:
City	:	NORWOOD
State	:	NC
Zip	:	28128-8445
Country	:	US
Telephone Number	:	704-474-4035
Fax Number	:	704-474-3551

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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