Provider Demographics
NPI:1669703484
Name:WHALEY, LARRY L (PHARMD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:L
Last Name:WHALEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1103
Mailing Address - Country:US
Mailing Address - Phone:423-586-4077
Mailing Address - Fax:423-318-2928
Practice Address - Street 1:3980 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1103
Practice Address - Country:US
Practice Address - Phone:423-586-4077
Practice Address - Fax:423-318-2928
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN24497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist