Provider Demographics
NPI:1972883908
Name:HUMPHREY, WILLIAM PHILLIP (RPH, CCP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PHILLIP
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:RPH, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 US HIGHWAY 31 N
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2143
Mailing Address - Country:US
Mailing Address - Phone:256-233-6335
Mailing Address - Fax:256-233-2614
Practice Address - Street 1:104 US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2143
Practice Address - Country:US
Practice Address - Phone:256-233-6335
Practice Address - Fax:256-233-2614
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist