Basic Information
Provider Information
NPI: 1003141250
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RICE
FirstName: WHITNEY
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 S 99TH AVE
Address2: FRY'S FOOD AND DRUG
City: TOLLESON
State: AZ
PostalCode: 853539700
CountryCode: US
TelephoneNumber: 6239074932
FaxNumber:  
Practice Location
Address1: 500 S 99TH AVE
Address2: FRY'S FOOD AND DRUG
City: TOLLESON
State: AZ
PostalCode: 853539700
CountryCode: US
TelephoneNumber: 6239074932
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/06/2009
LastUpdateDate: 12/03/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X16745AZY Pharmacy Service ProvidersPharmacist 

No ID Information.


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