Provider Demographics
NPI:1053964601
Name:WHITAKER, WILLIAM BLAKE (PHARMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLAKE
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LAKE DR APT P1
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4694
Mailing Address - Country:US
Mailing Address - Phone:828-280-2813
Mailing Address - Fax:
Practice Address - Street 1:3643 HOWARD GAP RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-3164
Practice Address - Country:US
Practice Address - Phone:828-698-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist