Provider Demographics
NPI:1932472503
Name:WHITNEY, JO ANN (RPH)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 HWY 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-8832
Mailing Address - Country:US
Mailing Address - Phone:541-997-3099
Mailing Address - Fax:541-997-3299
Practice Address - Street 1:4310 HWY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-8832
Practice Address - Country:US
Practice Address - Phone:541-997-3099
Practice Address - Fax:541-997-3299
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR009409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR009409OtherBOP/STATE LICENSE NUMBER