Provider Demographics
NPI:1598545451
Name:WHITAKER, HENRY III (RPH)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:WHITAKER
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4941
Mailing Address - Country:US
Mailing Address - Phone:606-767-3443
Mailing Address - Fax:
Practice Address - Street 1:7101 CEDAR SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-2587
Practice Address - Country:US
Practice Address - Phone:502-231-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist