Provider Demographics
NPI:1487907432
Name:WHITTLE, GREGORY RUBEN (RPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:RUBEN
Last Name:WHITTLE
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:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-9000
Mailing Address - Country:US
Mailing Address - Phone:866-229-7389
Mailing Address - Fax:
Practice Address - Street 1:2103 VETERANS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-7531
Practice Address - Country:US
Practice Address - Phone:866-229-7389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13589183500000X
TN67451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Yes183500000XPharmacy Service ProvidersPharmacist