Provider Demographics
NPI:1013949965
Name:GARRISON, WILLIAM F (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:GARRISON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SUMMIT AVE
Mailing Address - Street 2:PO BOX 127
Mailing Address - City:CENTER CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55012-0127
Mailing Address - Country:US
Mailing Address - Phone:651-257-4500
Mailing Address - Fax:651-257-8296
Practice Address - Street 1:320 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:CENTER CITY
Practice Address - State:MN
Practice Address - Zip Code:55012-0127
Practice Address - Country:US
Practice Address - Phone:651-257-4500
Practice Address - Fax:651-257-8296
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2613068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2410316OtherNABP
MN2613068OtherSTATE LICENSE
MN2613068OtherSTATE LICENSE