Provider Demographics
NPI:1881376119
Name:WHITSON, DERICK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DERICK
Middle Name:
Last Name:WHITSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 WESTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4258
Mailing Address - Country:US
Mailing Address - Phone:423-588-0791
Mailing Address - Fax:
Practice Address - Street 1:1004 SNAPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4029
Practice Address - Country:US
Practice Address - Phone:423-638-7552
Practice Address - Fax:423-638-2552
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty