Provider Demographics
NPI:1265729313
Name:WHITEHEAD, ALAN L (RPH)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:L
Last Name:WHITEHEAD
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 1:1200 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1634
Mailing Address - Country:US
Mailing Address - Phone:703-746-4850
Mailing Address - Fax:703-746-4851
Practice Address - Street 1:1200 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1634
Practice Address - Country:US
Practice Address - Phone:703-746-4850
Practice Address - Fax:703-746-4851
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist