Basic Information
| Provider Information | |||||||||
| NPI: | 1003155805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11315 ORE ST NE | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215028144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403361292 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 739 PARK ST | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215023172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017777670 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2013 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 0202009429 | VA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 19957 | MD | N | Pharmacy Service Providers | Pharmacist | 183500000X | RP0007582 | WV | N | Pharmacy Service Providers | Pharmacist |
No ID Information.