Provider Demographics
NPI:1861032336
Name:WHITMORE, REBECCA ROSE (PHARM D)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-2624
Mailing Address - Country:US
Mailing Address - Phone:985-735-6536
Mailing Address - Fax:
Practice Address - Street 1:329 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-2624
Practice Address - Country:US
Practice Address - Phone:985-735-6536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist