Provider Demographics
NPI:1336492057
Name:WHITEHEAD, WILLIAM MASSIE II (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MASSIE
Last Name:WHITEHEAD
Suffix:II
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:PO BOX 32660
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2660
Mailing Address - Country:US
Mailing Address - Phone:907-790-7252
Mailing Address - Fax:
Practice Address - Street 1:615 W WILLOUGHBY AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1731
Practice Address - Country:US
Practice Address - Phone:907-796-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1016OtherSTATE OF ALASKA PHARMACIST LICENSE