Provider Demographics
NPI:1225120983
Name:WHALEN, ROXANNE T (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:T
Last Name:WHALEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 E POTAWATOMI DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46538-9372
Mailing Address - Country:US
Mailing Address - Phone:574-453-2769
Mailing Address - Fax:574-267-8028
Practice Address - Street 1:2280 PROVIDENT CT STE D
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3284
Practice Address - Country:US
Practice Address - Phone:574-267-4900
Practice Address - Fax:574-267-8028
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018872A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist