MEDICARE: MR. WILLIAM WALDEN ABERNATHY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202005064	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0202005064	OTHER	VA	STATE LICENSE

General Provider Information

NPI Number	:	1003874215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM WALDEN ABERNATHY RPH

Provider Business Mailing Address
First Line	:	14242 COUNTRY CLUB DR
Second Line	:
City	:	ASHLAND
State	:	VA
Zip	:	23005-3138
Country	:	US
Telephone Number	:	804-798-7482
Fax Number	:

Provider Business Practice Location Address
First Line	:	18014 JEFFERSON DAVIS HWY
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-2922
Country	:	US
Telephone Number	:	804-448-2606
Fax Number	:	804-448-0159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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