Provider Demographics
NPI:1952626491
Name:WHALE, MICHAEL FORESTER (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FORESTER
Last Name:WHALE
Suffix:
Gender:M
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:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0902
Mailing Address - Country:US
Mailing Address - Phone:407-341-8348
Mailing Address - Fax:407-299-5814
Practice Address - Street 1:13105 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3922
Practice Address - Country:US
Practice Address - Phone:407-656-2604
Practice Address - Fax:407-656-1963
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist