Provider Demographics
NPI:1891835757
Name:JIMMIE LEE WHISENHUNT
Entity Type:Organization
Organization Name:JIMMIE LEE WHISENHUNT
Other - Org Name:WHISENHUNT'S CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WHISENHUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-547-2782
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:HOOKS
Mailing Address - State:TX
Mailing Address - Zip Code:75561-0129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOOKS
Practice Address - State:TX
Practice Address - Zip Code:75561-5155
Practice Address - Country:US
Practice Address - Phone:903-547-2782
Practice Address - Fax:903-547-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX11773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2090227OtherPK
TX102155Medicaid