Provider Demographics
NPI:1952901209
Name:WHITAKER, CASEY (PHARMD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:WHITAKER
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 1:70 HOLLY KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-2132
Mailing Address - Country:US
Mailing Address - Phone:540-493-5993
Mailing Address - Fax:
Practice Address - Street 1:400 OLD FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-5857
Practice Address - Country:US
Practice Address - Phone:540-483-2667
Practice Address - Fax:540-483-1624
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9866183500000X
CARPH70768183500000X
VA0202212247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist