Provider Demographics
NPI:1912171687
Name:WHALEN RODRIGUEZ, KERRYLYN (RPH)
Entity Type:Individual
Prefix:DR
First Name:KERRYLYN
Middle Name:
Last Name:WHALEN RODRIGUEZ
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 1:1251 W STEPHENSON ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4868
Mailing Address - Country:US
Mailing Address - Phone:815-232-6648
Mailing Address - Fax:815-232-2218
Practice Address - Street 1:1251 W STEPHENSON ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4868
Practice Address - Country:US
Practice Address - Phone:815-232-6648
Practice Address - Fax:815-232-2218
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist