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1700174935 NPI number — WILLIAM CARROLL COLVIN RPH

NPI Number: 1700174935
Health Care Provider/Practitioner: WILLIAM CARROLL COLVIN RPH

Information about “1700174935” NPI (WILLIAM CARROLL COLVIN RPH) exists in 1700174935 in HTML format HTML  |  1700174935 in plain Text format TXT  |  1700174935 in PDF (Portable Document Format) PDF  |  1700174935 in an XML format XML  formats.

NPI Number : 1700174935 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700174935",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLVIN",
    "FirstName": "WILLIAM",
    "MiddleName": "CARROLL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 669",
    "SecondLineMailingAddress": "114 SERIO BLVD.",
    "MailingAddressCityName": "FERRIDAY",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "71334-0669",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "318-757-4114",
    "MailingAddressFaxNumber": "318-757-4111",
    "FirstLinePracticeLocationAddress": "114 SERIO BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FERRIDAY",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "71334-2013",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "318-757-4114",
    "PracticeLocationAddressFaxNumber": "318-757-4111",
    "EnumerationDate": "07/21/2011",
    "LastUpdateDate": "07/21/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "10275",
        "LicenseNumberStateCode": "LA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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