Provider Demographics
NPI:1154790061
Name:WHITT, GINGER MARIE X
Entity type:Individual
Prefix:MS
First Name:GINGER
Middle Name:MARIE
Last Name:WHITT
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21195 HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:SHADY COVE
Mailing Address - State:OR
Mailing Address - Zip Code:97539-9715
Mailing Address - Country:US
Mailing Address - Phone:541-878-3151
Mailing Address - Fax:
Practice Address - Street 1:21195 HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:SHADY COVE
Practice Address - State:OR
Practice Address - Zip Code:97539-9715
Practice Address - Country:US
Practice Address - Phone:541-878-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist