Provider Demographics
NPI:1700155827
Name:WHALEN, WILLIAM FRANCIS
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FRANCIS
Last Name:WHALEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9223 CLEARLAKE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-4706
Mailing Address - Country:US
Mailing Address - Phone:619-443-2783
Mailing Address - Fax:
Practice Address - Street 1:1299 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4902
Practice Address - Country:US
Practice Address - Phone:619-441-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105923183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician