Provider Demographics
NPI:1558647404
Name:WHITSON, JEROME A (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:A
Last Name:WHITSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9580 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6140
Mailing Address - Country:US
Mailing Address - Phone:513-791-4390
Mailing Address - Fax:513-791-6579
Practice Address - Street 1:9580 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6140
Practice Address - Country:US
Practice Address - Phone:513-791-4390
Practice Address - Fax:513-791-6579
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist