Provider Demographics
NPI:1639104763
Name:MATHER, BILL (RPH)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:
Last Name:MATHER
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 1:202 SW KENT ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-1379
Mailing Address - Country:US
Mailing Address - Phone:641-743-2201
Mailing Address - Fax:641-743-2203
Practice Address - Street 1:202 SW KENT ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-1379
Practice Address - Country:US
Practice Address - Phone:641-743-2201
Practice Address - Fax:641-743-2203
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0766279Medicaid
IA0766279Medicaid