MEDICARE: TERESA ORR WHITAKER 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	E-08111	MS

General Provider Information

NPI Number	:	1477190486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ORR WHITAKER RPH

Provider Business Mailing Address
First Line	:	571 N LAKE CIR
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-4036
Country	:	US
Telephone Number	:	662-258-4871
Fax Number	:

Provider Business Practice Location Address
First Line	:	571 N LAKE CIR
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-4036
Country	:	US
Telephone Number	:	662-258-4871
Fax Number	:

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

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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Directions to “ TERESA ORR WHITAKER RPH” Practice Location

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