Provider Demographics
NPI:1578966172
Name:TABARES, WHITNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:TABARES
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 1:5836 WALSH PT APT 306
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1975
Mailing Address - Country:US
Mailing Address - Phone:913-909-2921
Mailing Address - Fax:
Practice Address - Street 1:3250 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4077
Practice Address - Country:US
Practice Address - Phone:719-866-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-27
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist