Provider Demographics
NPI:1831483049
Name:WHITSON, GARY BRYCE II (PHARMD, MSIA)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRYCE
Last Name:WHITSON
Suffix:II
Gender:M
Credentials:PHARMD, MSIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 STATE ST
Mailing Address - Street 2:T-0139
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4924
Mailing Address - Country:US
Mailing Address - Phone:812-945-4768
Mailing Address - Fax:812-945-4768
Practice Address - Street 1:2209 STATE ST
Practice Address - Street 2:T-0139
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4924
Practice Address - Country:US
Practice Address - Phone:812-945-4768
Practice Address - Fax:812-945-4768
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015060183500000X
IN26023672A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist