Provider Demographics
NPI:1003945429
Name:WHALEY, WARREN R (RPH)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:R
Last Name:WHALEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9569 TREETOP DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-8721
Mailing Address - Country:US
Mailing Address - Phone:269-665-9041
Mailing Address - Fax:
Practice Address - Street 1:5121 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-0404
Practice Address - Country:US
Practice Address - Phone:269-337-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist