Provider Demographics
NPI:1023659513
Name:WILTMAN, WILLIAM PATRICK (PHARMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:WILTMAN
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 1:3606 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-1004
Mailing Address - Country:US
Mailing Address - Phone:440-227-3774
Mailing Address - Fax:
Practice Address - Street 1:4106 E LAKE RD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD LAKE
Practice Address - State:OH
Practice Address - Zip Code:44054-1114
Practice Address - Country:US
Practice Address - Phone:440-949-6239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist