Provider Demographics
NPI:1902845381
Name:WHITFORD PHARMACY
Entity Type:Organization
Organization Name:WHITFORD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-776-4481
Mailing Address - Street 1:327 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1425
Mailing Address - Country:US
Mailing Address - Phone:608-776-4481
Mailing Address - Fax:608-776-2341
Practice Address - Street 1:327 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1425
Practice Address - Country:US
Practice Address - Phone:608-776-4481
Practice Address - Fax:608-776-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI80993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33020000Medicaid
WI33020000Medicaid