Provider Demographics
NPI:1477190486
Name:WHITAKER, TERESA ORR (RPH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ORR
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 N LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744-4036
Mailing Address - Country:US
Mailing Address - Phone:662-258-4871
Mailing Address - Fax:
Practice Address - Street 1:571 N LAKE CIR
Practice Address - Street 2:
Practice Address - City:EUPORA
Practice Address - State:MS
Practice Address - Zip Code:39744-4036
Practice Address - Country:US
Practice Address - Phone:662-258-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-08111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist