Provider Demographics
NPI:1235365008
Name:WHITT, KEISHA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:
Last Name:WHITT
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 1:2515 S HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-6141
Mailing Address - Country:US
Mailing Address - Phone:919-776-0733
Mailing Address - Fax:919-776-3925
Practice Address - Street 1:2515 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-6141
Practice Address - Country:US
Practice Address - Phone:919-776-0733
Practice Address - Fax:919-776-3925
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist