Provider Demographics
NPI:1326642935
Name:CALLAWAY, WILLIAM (PHARM D)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CALLAWAY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-4382
Mailing Address - Country:US
Mailing Address - Phone:540-809-8442
Mailing Address - Fax:
Practice Address - Street 1:6600 SPRINGFIELD MALL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1712
Practice Address - Country:US
Practice Address - Phone:703-921-9003
Practice Address - Fax:571-388-5217
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022149773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202214977OtherVIRGINIA BOARD OF PHARMACY LICENSE