Provider Demographics
NPI:1376910307
Name:WHITLEY, MICHAEL ALEXANDER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ALEXANDER
Other - Last Name:WHITLEY-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 PHILO CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1222
Mailing Address - Country:US
Mailing Address - Phone:203-313-8355
Mailing Address - Fax:
Practice Address - Street 1:200 UNIVERSAL DR N
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3156
Practice Address - Country:US
Practice Address - Phone:203-859-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist