Provider Demographics
NPI:1154460202
Name:GRIFFIN, WILLIAM WAYNE
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WAYNE
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GRANT ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:AL
Mailing Address - Zip Code:36053
Mailing Address - Country:US
Mailing Address - Phone:334-687-4360
Mailing Address - Fax:
Practice Address - Street 1:201 KIRKLAND STREET
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36310
Practice Address - Country:US
Practice Address - Phone:334-585-2288
Practice Address - Fax:334-585-3864
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist