Provider Demographics
NPI:1821346792
Name:BOSTON, WHITNEY MONIQUE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:MONIQUE
Last Name:BOSTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2423
Mailing Address - Country:US
Mailing Address - Phone:803-279-7470
Mailing Address - Fax:803-279-4791
Practice Address - Street 1:101 EDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2423
Practice Address - Country:US
Practice Address - Phone:803-279-7470
Practice Address - Fax:803-279-4791
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist