Provider Demographics
NPI:1174070981
Name:MCWHORTER, TABITHA WISHARD (PHARMD)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:WISHARD
Last Name:MCWHORTER
Suffix:
Gender:F
Credentials:PHARMD
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Other - Credentials:
Mailing Address - Street 1:1498 KLONDIKE RD SW
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5169
Mailing Address - Country:US
Mailing Address - Phone:770-761-7260
Mailing Address - Fax:678-413-1818
Practice Address - Street 1:1498 KLONDIKE RD SW
Practice Address - Street 2:SUITE 106
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5169
Practice Address - Country:US
Practice Address - Phone:770-761-7260
Practice Address - Fax:678-413-1818
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARPH0278681835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology