Provider Demographics
NPI:1912916149
Name:WHITEHEAD, TOMMY ELVIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:ELVIS
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13150 FRANKFORT RD
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-8810
Mailing Address - Country:US
Mailing Address - Phone:256-381-4974
Mailing Address - Fax:256-757-9850
Practice Address - Street 1:1621 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-9142
Practice Address - Country:US
Practice Address - Phone:256-757-2166
Practice Address - Fax:256-757-9580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist