Provider Demographics
NPI:1447562624
Name:WHITAKER, ERYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERYN
Middle Name:
Last Name:WHITAKER
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 1:308 E PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4505
Mailing Address - Country:US
Mailing Address - Phone:707-462-1265
Mailing Address - Fax:
Practice Address - Street 1:308 E PERKINS ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4505
Practice Address - Country:US
Practice Address - Phone:707-462-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63021183500000X
OR12208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist