Provider Demographics
NPI:1497942056
Name:WHALEY'S PHARMACY INC
Entity Type:Organization
Organization Name:WHALEY'S PHARMACY INC
Other - Org Name:WHALEY'S SOUTHWEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DARRYL
Authorized Official - Last Name:HUBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:573-632-2021
Mailing Address - Street 1:1431 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2468
Mailing Address - Country:US
Mailing Address - Phone:573-634-3606
Mailing Address - Fax:573-634-6206
Practice Address - Street 1:630 E HIGH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3219
Practice Address - Country:US
Practice Address - Phone:573-632-2021
Practice Address - Fax:573-636-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030298443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy