Active NPI
Jerry Donald Whiteside Jr., R.PH.
- Pharmacist
- Huntsville, AL
National Provider Identifier
1427330208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12196
- Practice address
- 3120 Bob Wallace Ave SW
Huntsville, AL 35805-4004 - Phone
- (256) 533-5058
- Fax
- (256) 533-6967
- NPI assigned
- Sep 16, 2011
- Last updated
- Sep 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12196 | AL | Primary |
Addresses
Primary practice location
3120 Bob Wallace Ave SW
Huntsville, AL 35805-4004
Mailing address
3120 Bob Wallace Ave SW
Huntsville, AL 35805-4004
Phone (256) 533-5058
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12196 | AL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316131200000",
"number": "1427330208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3120 BOB WALLACE AVE SW",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358054004",
"telephone_number": "256-533-5058",
"fax_number": "256-533-6967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3120 BOB WALLACE AVE SW",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358054004",
"telephone_number": "256-533-5058",
"fax_number": "256-533-6967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITESIDE",
"first_name": "JERRY",
"middle_name": "DONALD",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-16",
"last_updated": "2011-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "12196",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntsville, AL
- Brittany Whitener, CRNP
- Whitesburg Dental Design, LLC
- Whitesburg Family Medicine
- Whitesburg Gardens, LLC (Whitesburg Gardens Health Care Center)
- Whitesburg SNF Operations LLC (Rocket City Rehabilitation and Healthcare Center)
- Clinton Harris Whitley, CRNA, DNP
- William Whitmer
- Heather R Whitmore, LMT
- Ciara Whitt
- Lauren Whitt, PHARMD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.