Provider Demographics
NPI:1538840210
Name:WHITEHALL PHARMACY LLC
Entity type:Organization
Organization Name:WHITEHALL PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-671-4914
Mailing Address - Street 1:205 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-4443
Mailing Address - Country:US
Mailing Address - Phone:870-380-5810
Mailing Address - Fax:
Practice Address - Street 1:2302 W 28TH AVE STE B
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5081
Practice Address - Country:US
Practice Address - Phone:870-671-4914
Practice Address - Fax:870-671-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy