Provider Demographics
NPI:1093829061
Name:WHITAKER DRUGS THOMASVILLE LLC
Entity type:Organization
Organization Name:WHITAKER DRUGS THOMASVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-599-8528
Mailing Address - Street 1:470 SAFFORD AVE W
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-3112
Mailing Address - Country:US
Mailing Address - Phone:334-636-9809
Mailing Address - Fax:334-636-9807
Practice Address - Street 1:470 SAFFORD AVE W
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3112
Practice Address - Country:US
Practice Address - Phone:334-636-9809
Practice Address - Fax:334-636-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1038693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL124922Medicaid
1991227OtherPK