Healthcare Provider Details

I. General information

NPI: 1336172964
Provider Name (Legal Business Name): WILLIAM BOONE DOTTEN BS IN PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O FOOD CITY PHARMACY WISE SHOPPING CENTER
NORTON VA
24273
US

IV. Provider business mailing address

11509 OLD NORTON COEBURN RD
COEBURN VA
24230-6511
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-7850
  • Fax:
Mailing address:
  • Phone: 276-395-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202003862
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: