Provider Demographics
NPI:1508579418
Name:WHALEN, AUDREY ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ELIZABETH
Last Name:WHALEN
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 1:102 MOUNT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-1657
Mailing Address - Country:US
Mailing Address - Phone:401-741-1585
Mailing Address - Fax:
Practice Address - Street 1:1086 WILLETT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2067
Practice Address - Country:US
Practice Address - Phone:401-433-5710
Practice Address - Fax:401-433-5713
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist