Provider Demographics
NPI:1750895876
Name:WHITTON, ANSON MARDELL (RPH)
Entity type:Individual
Prefix:MR
First Name:ANSON
Middle Name:MARDELL
Last Name:WHITTON
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 1:721 MECHEM DR STE B
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6911
Mailing Address - Country:US
Mailing Address - Phone:575-630-1080
Mailing Address - Fax:575-630-1083
Practice Address - Street 1:721 MECHEM DR STE B
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6911
Practice Address - Country:US
Practice Address - Phone:575-630-1080
Practice Address - Fax:575-630-1083
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist