Healthcare Provider Details

I. General information

NPI: 1902329303
Provider Name (Legal Business Name): WILLIAM E. WEATHERFORD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 4TH ST NW
RED BAY AL
35582-3953
US

IV. Provider business mailing address

PO BOX 1082
RED BAY AL
35582-1082
US

V. Phone/Fax

Practice location:
  • Phone: 256-356-4044
  • Fax: 256-356-4045
Mailing address:
  • Phone: 256-356-4044
  • Fax: 256-356-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114735
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: