Provider Demographics
NPI:1770609778
Name:WHITNEY, KATHLEEN M (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1704
Mailing Address - Country:US
Mailing Address - Phone:978-458-2334
Mailing Address - Fax:978-452-5686
Practice Address - Street 1:777 ROGERS ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4336
Practice Address - Country:US
Practice Address - Phone:978-453-7257
Practice Address - Fax:978-452-5686
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16771183500000X
NH2114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist