Provider Demographics
NPI:1801343363
Name:WHITMORE, KATHLEEN (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:SPRINGERVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85938-0111
Mailing Address - Country:US
Mailing Address - Phone:928-333-2916
Mailing Address - Fax:928-333-4328
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938
Practice Address - Country:US
Practice Address - Phone:928-333-2916
Practice Address - Fax:928-333-4328
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist