Provider Demographics
NPI:1144525221
Name:WHITFIELD, MICHAEL A (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:WHITFIELD
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 1:1056 FALLWAY DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-3294
Mailing Address - Country:US
Mailing Address - Phone:317-398-7231
Mailing Address - Fax:317-421-2022
Practice Address - Street 1:1408 MILLER AVE STE A
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-3279
Practice Address - Country:US
Practice Address - Phone:317-421-2020
Practice Address - Fax:317-421-2022
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012721A1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26012721AOtherSTATE PHARMACY LICENSE