MEDICARE: DR. ELIJAH SETH WHITAKER 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	019362	KY

General Provider Information

NPI Number	:	1619561131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIJAH SETH WHITAKER PHARMD

Provider Business Mailing Address
First Line	:	4143 RESERVOIR AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-2038
Country	:	US
Telephone Number	:	859-408-6796
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 HIGHWAY 42 E
Second Line	:
City	:	BEDFORD
State	:	KY
Zip	:	40006-7624
Country	:	US
Telephone Number	:	502-255-3540
Fax Number	:	502-255-3615

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

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	02/24/2021

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