Provider Demographics
NPI:1760764567
Name:WHITAKER, EMILY J (R PH)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:DICKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 E IL ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-9694
Mailing Address - Country:US
Mailing Address - Phone:815-562-3414
Mailing Address - Fax:
Practice Address - Street 1:311 E IL ROUTE 38
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-9694
Practice Address - Country:US
Practice Address - Phone:815-562-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist