Provider Demographics
NPI:1932518412
Name:WHITTAKER, JOANNE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:WHITTAKER
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 1:7319 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-6051
Mailing Address - Country:US
Mailing Address - Phone:208-853-4780
Mailing Address - Fax:208-853-4782
Practice Address - Street 1:7319 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6051
Practice Address - Country:US
Practice Address - Phone:208-853-4780
Practice Address - Fax:208-853-4782
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist