MEDICARE: MR. JERRY DAVID WHITACRE 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	22685	CA

General Provider Information

NPI Number	:	1568767689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY DAVID WHITACRE RPH

Provider Business Mailing Address
First Line	:	5949 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3752
Country	:	US
Telephone Number	:	562-496-1851
Fax Number	:	562-496-1251

Provider Business Practice Location Address
First Line	:	5949 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3752
Country	:	US
Telephone Number	:	562-496-1851
Fax Number	:	562-496-1251

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

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	03/22/2026

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