Healthcare Provider Details

I. General information

NPI: 1639486848
Provider Name (Legal Business Name): WILLIAM JOHN NELSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7835 MAPLE AVE
PENNSAUKEN NJ
08109-3395
US

IV. Provider business mailing address

34 UNION ST
MOUNT HOLLY NJ
08060-1825
US

V. Phone/Fax

Practice location:
  • Phone: 856-663-6655
  • Fax:
Mailing address:
  • Phone: 856-495-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03128700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: