MEDICARE: MR. WILLIAM CHARLES DWYER R. PH.

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	15411	CO
2	183500000X	Pharmacist	22141	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	595699675	OTHER	TX	USA PASSPORT

General Provider Information

NPI Number	:	1356938278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CHARLES DWYER R. PH.

Provider Business Mailing Address
First Line	:	PO BOX 1757
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-1382
Country	:	US
Telephone Number	:	281-433-9356
Fax Number	:	936-588-0605

Provider Business Practice Location Address
First Line	:	2507 SAND SHORE DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-1524
Country	:	US
Telephone Number	:	281-433-9356
Fax Number	:	936-588-0605

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

Provider Enumeration Date	:	12/26/2020
Last Update Date	:	12/26/2020

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