Provider Demographics
NPI:1093915332
Name:WHITMER, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WHITMER
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 1:3211 TRENTON PL SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1291
Mailing Address - Country:US
Mailing Address - Phone:256-221-2472
Mailing Address - Fax:256-830-2548
Practice Address - Street 1:444 WYNN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-3426
Practice Address - Country:US
Practice Address - Phone:256-837-6240
Practice Address - Fax:256-830-2548
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3633Medicaid