Provider Demographics
NPI:1003874215
Name:ABERNATHY, WILLIAM WALDEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WALDEN
Last Name:ABERNATHY
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 1:14242 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-3138
Mailing Address - Country:US
Mailing Address - Phone:804-798-7482
Mailing Address - Fax:
Practice Address - Street 1:18014 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2922
Practice Address - Country:US
Practice Address - Phone:804-448-2606
Practice Address - Fax:804-448-0159
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202005064OtherSTATE LICENSE