Provider Demographics
NPI:1770693053
Name:WHITEHOUSE, TINA A (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:A
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1 FREEDOM WAY
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6258
Mailing Address - Country:US
Mailing Address - Phone:706-738-8190
Mailing Address - Fax:706-823-1753
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-738-8190
Practice Address - Fax:706-823-1753
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0139351835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy