Provider Demographics
NPI:1124876503
Name:WHITTIER, MARK ALEXANDER (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALEXANDER
Last Name:WHITTIER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:MN
Mailing Address - Zip Code:56220-9272
Mailing Address - Country:US
Mailing Address - Phone:507-829-4169
Mailing Address - Fax:
Practice Address - Street 1:130 SAINT OLAF AVE N
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:MN
Practice Address - Zip Code:56220-1372
Practice Address - Country:US
Practice Address - Phone:507-223-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist