Provider Demographics
NPI:1760504740
Name:WHITING, STEVEN RUSSELL (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RUSSELL
Last Name:WHITING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:2906 PINEWOOD DR
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-0075
Mailing Address - Country:US
Mailing Address - Phone:712-336-5439
Mailing Address - Fax:
Practice Address - Street 1:1221 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2432
Practice Address - Country:US
Practice Address - Phone:712-362-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist