Provider Demographics
NPI:1073647343
Name:WHITNEY, AMY ALEXANDRA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ALEXANDRA
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ALEXANDRA
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1413 GILLETTS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9640
Mailing Address - Country:US
Mailing Address - Phone:517-990-7628
Mailing Address - Fax:
Practice Address - Street 1:7080 DEXTER- ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130
Practice Address - Country:US
Practice Address - Phone:734-424-0398
Practice Address - Fax:734-424-0498
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist