Provider Demographics
NPI:1407676497
Name:WHITESELL, RICHARD JONES
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JONES
Last Name:WHITESELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 WESTPOINT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6723
Mailing Address - Country:US
Mailing Address - Phone:336-773-1013
Mailing Address - Fax:336-397-0165
Practice Address - Street 1:3917 WESTPOINT BLVD STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6723
Practice Address - Country:US
Practice Address - Phone:336-773-1013
Practice Address - Fax:336-397-0165
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist