Provider Demographics
NPI:1215210794
Name:WHITT, GARRETT PAYTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:PAYTON
Last Name:WHITT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CARLYLE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-6223
Mailing Address - Country:US
Mailing Address - Phone:618-222-1827
Mailing Address - Fax:
Practice Address - Street 1:515 CARLYLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-6223
Practice Address - Country:US
Practice Address - Phone:618-222-1827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010027767183500000X
IL051294514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist