1336172964 NPI number — MR. WILLIAM BOONE DOTTEN BS IN PHARMACY

Table of content: MR. WILLIAM BOONE DOTTEN BS IN PHARMACY (NPI 1336172964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336172964 NPI number — MR. WILLIAM BOONE DOTTEN BS IN PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOTTEN
Provider First Name:
WILLIAM
Provider Middle Name:
BOONE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BS IN PHARMACY
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336172964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11509 OLD NORTON COEBURN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24230-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-395-2163
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
C/O FOOD CITY PHARMACY
Provider Second Line Business Practice Location Address:
WISE SHOPPING CENTER
Provider Business Practice Location Address City Name:
NORTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-679-7850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0202003862 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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