Individual
DELISA RUSSELL WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Mailing address
1836 FAIRPOINTE TRCE, STONE MOUNTAIN, GA 30088-4023
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14757
GA
Other
Enumeration date
06/30/2006
Last updated
07/08/2007
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