Provider Demographics
NPI:1336353713
Name:WHETSEL, TARA RAQUEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:RAQUEL
Last Name:WHETSEL
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 1:1124 HSN PO BOX 9520
Mailing Address - Street 2:WVU SCHOOL OF PHARMACY
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9520
Mailing Address - Country:US
Mailing Address - Phone:304-293-6203
Mailing Address - Fax:304-293-7672
Practice Address - Street 1:341 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5504
Practice Address - Country:US
Practice Address - Phone:304-292-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist