Provider Demographics
NPI:1760472674
Name:WHITLEY, HEATHER PHILLIPS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:PHILLIPS
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BOX 870326
Mailing Address - Street 2:RURAL HEALTH INSTITUTE
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:25487-0326
Mailing Address - Country:US
Mailing Address - Phone:205-348-1333
Mailing Address - Fax:205-348-9417
Practice Address - Street 1:16063 HWY 69 SOUTH
Practice Address - Street 2:MOUNDVILLE MEDICAL CENTER
Practice Address - City:MOUNDVILLE
Practice Address - State:AL
Practice Address - Zip Code:35474
Practice Address - Country:US
Practice Address - Phone:205-371-2267
Practice Address - Fax:205-371-2901
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010942183500000X
AL132101835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist