Provider Demographics
NPI:1740352731
Name:ELKINS, WILLIAM ALLEN (PHARM D)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLEN
Last Name:ELKINS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 LAKE ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39827-1036
Mailing Address - Country:US
Mailing Address - Phone:229-327-6962
Mailing Address - Fax:
Practice Address - Street 1:616 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5551
Practice Address - Country:US
Practice Address - Phone:229-223-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30206183500000X
GA17958183500000X
GARPH017958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003203698AMedicaid