Provider Demographics
NPI:1962006478
Name:WHITAKER, JANDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANDA
Middle Name:
Last Name:WHITAKER
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 1:16600 S FM 1258
Mailing Address - Street 2:
Mailing Address - City:CLAUDE
Mailing Address - State:TX
Mailing Address - Zip Code:79019-3705
Mailing Address - Country:US
Mailing Address - Phone:806-335-2072
Mailing Address - Fax:
Practice Address - Street 1:317 E AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5269
Practice Address - Country:US
Practice Address - Phone:806-374-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist