Provider Demographics
NPI:1922609197
Name:WHITKANACK, AMELIA ROSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:ROSE
Last Name:WHITKANACK
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 1:168 TRAVIS LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-6550
Mailing Address - Country:US
Mailing Address - Phone:479-214-7565
Mailing Address - Fax:
Practice Address - Street 1:1176 STATE HIGHWAY 22 W STE A
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3006
Practice Address - Country:US
Practice Address - Phone:479-229-4040
Practice Address - Fax:479-229-4049
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist