Provider Demographics
NPI:1285006452
Name:SI, WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1287
Mailing Address - Country:US
Mailing Address - Phone:203-439-9099
Mailing Address - Fax:631-393-6922
Practice Address - Street 1:1492 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410
Practice Address - Country:US
Practice Address - Phone:203-439-9099
Practice Address - Fax:631-393-6922
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist