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General NPI Number Information
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NPI Number | 1376830653
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Entity Type | Individual
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Provider Name | PAUL WILLIAM WILLIS RPH
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Gender | Male
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 807 S. MAIN ST.
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City | YREKA
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State | CA
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Zip | 96097
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Country | US
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Telephone | 530-842-5596
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Fax | 530-842-2882
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Provider Business Mailing Address
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Address Line | 12117 OLD WESTSIDE RD
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City | GRENADA
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State | CA
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Zip | 96038-9607
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Country | US
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Telephone | 530-859-0415
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Fax | 530-436-2454
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH27113
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License Number State | CA
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