Provider Demographics
NPI:1497094676
Name:WHELCHEL, KRISTEN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:WHELCHEL
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 COLISEUM DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3865
Mailing Address - Country:US
Mailing Address - Phone:478-741-8599
Mailing Address - Fax:478-741-8598
Practice Address - Street 1:308 COLISEUM DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3865
Practice Address - Country:US
Practice Address - Phone:478-741-8599
Practice Address - Fax:478-741-8598
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA021652OtherGEORGIA STATE BOARD OF PHARMACY