Provider Demographics
NPI:1114394038
Name:WHELAN, KEVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:WHELAN
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 1:4467 POINCIANA ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4414
Mailing Address - Country:US
Mailing Address - Phone:954-257-0868
Mailing Address - Fax:
Practice Address - Street 1:4467 POINCIANA ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-4414
Practice Address - Country:US
Practice Address - Phone:954-257-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS26103OtherPHARMACIST