Provider Demographics
NPI:1942814785
Name:HORNER, WILLAIM MATTHEW
Entity Type:Individual
Prefix:
First Name:WILLAIM
Middle Name:MATTHEW
Last Name:HORNER
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 1:3160 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1603
Mailing Address - Country:US
Mailing Address - Phone:314-837-4332
Mailing Address - Fax:314-831-1712
Practice Address - Street 1:3160 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1603
Practice Address - Country:US
Practice Address - Phone:314-837-4332
Practice Address - Fax:314-831-1712
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist