MEDICARE: WHITNEY SHIRLEY PHARMD

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	RPH027914	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	183500000X	OTHER	GA	RTIE AID PHARMACY

General Provider Information

NPI Number	:	1467869891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY SHIRLEY PHARMD

Provider Business Mailing Address
First Line	:	75 DEER RUN
Second Line	:
City	:	JASPER
State	:	GA
Zip	:	30143-8901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3640 MUNDY MILL RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-8218
Country	:	US
Telephone Number	:	770-531-7858
Fax Number	:

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

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2014

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Directions to “ WHITNEY SHIRLEY PHARMD” Practice Location

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