Provider Demographics
NPI:1750031605
Name:WHITEAKER, DAVID S JR
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:WHITEAKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 STATE ROAD CC
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-3682
Mailing Address - Country:US
Mailing Address - Phone:636-634-0105
Mailing Address - Fax:
Practice Address - Street 1:2020 ROCK RD
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-1052
Practice Address - Country:US
Practice Address - Phone:636-586-1766
Practice Address - Fax:636-586-0007
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician