Provider Demographics
NPI:1003155805
Name:PEARSON, WILLIAM LEE (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEE
Last Name:PEARSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 ORE ST NE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-8144
Mailing Address - Country:US
Mailing Address - Phone:540-336-1292
Mailing Address - Fax:
Practice Address - Street 1:739 PARK ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3172
Practice Address - Country:US
Practice Address - Phone:301-777-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009429183500000X
MD19957183500000X
WVRP0007582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist