Provider Demographics
NPI:1669011839
Name:DREHER, WILLIAM DERRELL
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DERRELL
Last Name:DREHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 DREHER RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-4783
Mailing Address - Country:US
Mailing Address - Phone:501-658-0450
Mailing Address - Fax:
Practice Address - Street 1:6420 COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7724
Practice Address - Country:US
Practice Address - Phone:501-565-0188
Practice Address - Fax:501-565-9616
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist