Provider Demographics
NPI:1144206491
Name:PAIGE, BILL HAROLD (RPH)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:HAROLD
Last Name:PAIGE
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 1:401 CRESCENT AVE
Mailing Address - Street 2:P O BOX 1543
Mailing Address - City:AVALON
Mailing Address - State:CA
Mailing Address - Zip Code:90704-1543
Mailing Address - Country:US
Mailing Address - Phone:310-510-0189
Mailing Address - Fax:310-510-2585
Practice Address - Street 1:401 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:CA
Practice Address - Zip Code:90704-1543
Practice Address - Country:US
Practice Address - Phone:310-510-0189
Practice Address - Fax:310-510-2585
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist