Provider Demographics
NPI:1356482665
Name:CARROLL, WILLIAM WESLEY (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WESLEY
Last Name:CARROLL
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 1:3339 MEADOW GREEN CT
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1143
Mailing Address - Country:US
Mailing Address - Phone:513-752-9825
Mailing Address - Fax:
Practice Address - Street 1:3339 MEADOW GREEN CT
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1143
Practice Address - Country:US
Practice Address - Phone:513-752-9825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-11842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist