Provider Demographics
NPI:1114582236
Name:SAWYER, WILLIAM THERON (BSPHARM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THERON
Last Name:SAWYER
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:KENTS STORE
Mailing Address - State:VA
Mailing Address - Zip Code:23084-0070
Mailing Address - Country:US
Mailing Address - Phone:919-450-5288
Mailing Address - Fax:
Practice Address - Street 1:211 KENTS STORE WAY
Practice Address - Street 2:
Practice Address - City:KENTS STORE
Practice Address - State:VA
Practice Address - Zip Code:23084-0070
Practice Address - Country:US
Practice Address - Phone:919-450-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist