Provider Demographics
NPI:1689985814
Name:WHITLOCK, ANDREW LUKE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LUKE
Last Name:WHITLOCK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4542 HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-3009
Mailing Address - Country:US
Mailing Address - Phone:423-892-6787
Mailing Address - Fax:423-892-4621
Practice Address - Street 1:4542 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-3009
Practice Address - Country:US
Practice Address - Phone:423-892-6787
Practice Address - Fax:423-892-4621
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21727183500000X
VA0202205369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist