Provider Demographics
NPI:1528231313
Name:SHIRLEY, WILLIAM R (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:SHIRLEY
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 1:309 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29832-1338
Mailing Address - Country:US
Mailing Address - Phone:803-275-4524
Mailing Address - Fax:
Practice Address - Street 1:310 E MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-4261
Practice Address - Country:US
Practice Address - Phone:803-278-3673
Practice Address - Fax:803-442-3824
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist