Provider Demographics
NPI:1053638056
Name:WHITING, PHIL EDWARD
Entity Type:Individual
Prefix:MR
First Name:PHIL
Middle Name:EDWARD
Last Name:WHITING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9534 DEEP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8379
Mailing Address - Country:US
Mailing Address - Phone:760-247-1123
Mailing Address - Fax:
Practice Address - Street 1:12253 APPLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-1701
Practice Address - Country:US
Practice Address - Phone:760-247-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH37563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist