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 1:24 CLAY ST STE P
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2810
Practice Address - Country:US
Practice Address - Phone:276-226-1157
Practice Address - Fax:276-226-9382
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH70768183500000X
VA0202212247183500000X
IDP9866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist