Provider Demographics
NPI:1669745634
Name:WHITLEY, CHRIS EDWARD (RPH)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:EDWARD
Last Name:WHITLEY
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 1:1900 SE SEDGWICK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-9500
Mailing Address - Country:US
Mailing Address - Phone:360-874-7173
Mailing Address - Fax:360-874-7167
Practice Address - Street 1:1900 SE SEDGWICK RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-9500
Practice Address - Country:US
Practice Address - Phone:360-874-7173
Practice Address - Fax:360-874-7167
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist