Provider Demographics
NPI:1891107827
Name:RUTHERFORD, WILLIAM KENDALL (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KENDALL
Last Name:RUTHERFORD
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 1:7292 HIGHWAY 509
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-6476
Mailing Address - Country:US
Mailing Address - Phone:318-872-5700
Mailing Address - Fax:318-872-6870
Practice Address - Street 1:7292 HIGHWAY 509
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-6476
Practice Address - Country:US
Practice Address - Phone:318-872-5700
Practice Address - Fax:318-872-6870
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist