Provider Demographics
NPI:1619561131
Name:WHITAKER, ELIJAH SETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:SETH
Last Name:WHITAKER
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 1:4143 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-2038
Mailing Address - Country:US
Mailing Address - Phone:859-408-6796
Mailing Address - Fax:
Practice Address - Street 1:325 HIGHWAY 42 E
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:KY
Practice Address - Zip Code:40006-7624
Practice Address - Country:US
Practice Address - Phone:502-255-3540
Practice Address - Fax:502-255-3615
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist