MEDICARE: WILLIAM FRANCIS WHALEN

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	183700000X	Pharmacy Technician	105923	CA

General Provider Information

NPI Number	:	1700155827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM FRANCIS WHALEN

Provider Business Mailing Address
First Line	:	9223 CLEARLAKE WAY
Second Line	:
City	:	LAKESIDE
State	:	CA
Zip	:	92040-4706
Country	:	US
Telephone Number	:	619-443-2783
Fax Number	:

Provider Business Practice Location Address
First Line	:	1299 BROADWAY
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-4902
Country	:	US
Telephone Number	:	619-441-8040
Fax Number	:

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

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/19/2011

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