Provider Demographics
NPI:1568956779
Name:MAYBERRY, WILLIAM NOLAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NOLAN
Last Name:MAYBERRY
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 1:401 W PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1606
Mailing Address - Country:US
Mailing Address - Phone:931-729-9541
Mailing Address - Fax:931-729-4874
Practice Address - Street 1:401 W PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1606
Practice Address - Country:US
Practice Address - Phone:931-729-9541
Practice Address - Fax:931-729-4874
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist