Provider Demographics
NPI:1538225800
Name:WHITLEY DRUGS INC
Entity type:Organization
Organization Name:WHITLEY DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHRM
Authorized Official - Phone:828-692-4266
Mailing Address - Street 1:605 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4205
Mailing Address - Country:US
Mailing Address - Phone:828-692-4266
Mailing Address - Fax:828-692-7808
Practice Address - Street 1:605 5TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4205
Practice Address - Country:US
Practice Address - Phone:828-692-4266
Practice Address - Fax:828-692-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
NC060243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0455550Medicaid
2069154OtherPK
0150340002Medicare NSC