Healthcare Provider Details

I. General information

NPI: 1154460202
Provider Name (Legal Business Name): WILLIAM WAYNE GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KIRKLAND STREET
ABBEVILLE AL
36310
US

IV. Provider business mailing address

55 GRANT ROAD
MIDWAY AL
36053
US

V. Phone/Fax

Practice location:
  • Phone: 334-585-2288
  • Fax: 334-585-3864
Mailing address:
  • Phone: 334-687-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9877
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: