Provider Demographics
NPI:1437434958
Name:SUDDEATH, WILLIAM MARION (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARION
Last Name:SUDDEATH
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 1:713 N WOODSON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3813
Mailing Address - Country:US
Mailing Address - Phone:931-358-0518
Mailing Address - Fax:
Practice Address - Street 1:2975 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3021
Practice Address - Country:US
Practice Address - Phone:931-431-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist