Provider Demographics
NPI:1639583701
Name:WHITTAKER, DAVID CASEY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CASEY
Last Name:WHITTAKER
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 1:121 BISHOP ST CLINIC
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-7862
Mailing Address - Country:US
Mailing Address - Phone:065-282-1246
Mailing Address - Fax:606-546-6992
Practice Address - Street 1:121 BISHOP ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1702
Practice Address - Country:US
Practice Address - Phone:606-528-2124
Practice Address - Fax:606-546-6992
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist