Provider Demographics
NPI:1285666115
Name:WHATLEY, REBECCA LOUISE (PH TECH)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LOUISE
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:PH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14042 N COUNTY ROAD 1880
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-3217
Mailing Address - Country:US
Mailing Address - Phone:580-679-3734
Mailing Address - Fax:
Practice Address - Street 1:205 S PARK LN STE 110
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5733
Practice Address - Country:US
Practice Address - Phone:580-482-6464
Practice Address - Fax:580-480-3114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT-2189183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician