Basic Information
| Provider Information | |||||||||
| NPI: | 1770693053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITEHOUSE | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | RPH, PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FREEDOM WAY | ||||||||
| Address2: | VA MEDICAL CENTER | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309046258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067388190 | ||||||||
| FaxNumber: | 7068231753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 FREEDOM WAY | ||||||||
| Address2: | VA MEDICAL CENTER | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309046258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067388190 | ||||||||
| FaxNumber: | 7068231753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 013935 | GA | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.