Basic Information
Provider Information
NPI: 1003155805
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEARSON
FirstName: WILLIAM
MiddleName: LEE
NamePrefix:  
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XRP0007582WVN Pharmacy Service ProvidersPharmacist 
183500000X19957MDN Pharmacy Service ProvidersPharmacist 
183500000X0202009429VAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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