Provider Demographics
NPI:1154806396
Name:WHEADON, COLTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COLTON
Middle Name:
Last Name:WHEADON
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 1:314 COPA DE ORO DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-7017
Mailing Address - Country:US
Mailing Address - Phone:714-742-1263
Mailing Address - Fax:
Practice Address - Street 1:2973 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3425
Practice Address - Country:US
Practice Address - Phone:805-682-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist