Provider Demographics
NPI:1184231961
Name:STEWART, WILLIAM FORREST (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:FORREST
Last Name:STEWART
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 1:400 30TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3318
Mailing Address - Country:US
Mailing Address - Phone:510-628-0954
Mailing Address - Fax:888-972-6505
Practice Address - Street 1:400 30TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3318
Practice Address - Country:US
Practice Address - Phone:510-628-0954
Practice Address - Fax:888-972-6505
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50391183500000X
NC8782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist