Provider Demographics
NPI:1639952344
Name:WEBSTER, WILLIAM JACOB (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JACOB
Last Name:WEBSTER
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 1:2140 FORT HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-1522
Mailing Address - Country:US
Mailing Address - Phone:812-251-6440
Mailing Address - Fax:
Practice Address - Street 1:2140 FORT HARRISON RD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-1522
Practice Address - Country:US
Practice Address - Phone:812-466-6545
Practice Address - Fax:812-466-5248
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030332A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty