Provider Demographics
NPI:1073675336
Name:WHITMORE, JOHANNA MARIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:MARIA
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W 86TH ST
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-0970
Mailing Address - Country:US
Mailing Address - Phone:317-338-3682
Mailing Address - Fax:317-338-3041
Practice Address - Street 1:2001 W 86TH ST
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-0970
Practice Address - Country:US
Practice Address - Phone:317-338-3682
Practice Address - Fax:317-338-3041
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist