MEDICARE: MR. WILLIAM HUBERT RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-1-22920	OH
2	177F00000X	Lodging Provider	03122920	OH

General Provider Information

NPI Number	:	1407137748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM HUBERT RPH

Provider Business Mailing Address
First Line	:	4024 FULTON DR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2866
Country	:	US
Telephone Number	:	330-493-8431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 13TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-3118
Country	:	US
Telephone Number	:	330-445-1085
Fax Number	:	330-445-1075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	12/17/2024

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