Provider Demographics
NPI:1760125280
Name:FAKOLADE, WHITNEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:
Last Name:FAKOLADE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7507
Mailing Address - Country:US
Mailing Address - Phone:512-279-0985
Mailing Address - Fax:512-279-0471
Practice Address - Street 1:4303 VICTORY DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7507
Practice Address - Country:US
Practice Address - Phone:512-279-0985
Practice Address - Fax:512-279-0471
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74702OtherTEXAS BOARD OF PHARMACY
CA86008OtherCALIFORNIA BOARD OF PHARMACY