Benjamin H Whitesell
Individual provider Active NPI Pharmacist · Fulton, KY
NPI 1255823639 · NPPES record last updated Jun 1, 2018
Key facts
- NPI
- 1255823639
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 016028 (KY)
- Practice address
- 1405 Middle Rd
Fulton, KY 42041-7905 - Phone
- (270) 472-9802
- NPI assigned
- Jun 1, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016028 | KY | MD | Pharmacist |
| 39258 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Wal-Mart Stores East, LP | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 39258 | TN | |
| Pharmacist | 183500000X | 016028 | KY | Yes |
Addresses
Primary practice location
1405 Middle Rd
Fulton, KY 42041-7905
Mailing address
305 Park Ave
Fulton, KY 42041-1516
Other providers in Fulton, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.