Provider Demographics
NPI:1932703881
Name:MYLUM, WHITNEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:
Last Name:MYLUM
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 1:2738 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1906
Mailing Address - Country:US
Mailing Address - Phone:804-359-2497
Mailing Address - Fax:804-355-8295
Practice Address - Street 1:2738 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1906
Practice Address - Country:US
Practice Address - Phone:804-359-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist