Provider Demographics
NPI:1164650172
Name:WILL, AUTUMN NICHOLE
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:NICHOLE
Last Name:WILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3284 ALLEGHENY RD
Mailing Address - Street 2:
Mailing Address - City:MANNS CHOICE
Mailing Address - State:PA
Mailing Address - Zip Code:15550-7368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 S CENTER AVE STE 1049
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2033
Practice Address - Country:US
Practice Address - Phone:814-443-5352
Practice Address - Fax:814-443-5119
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist