Provider Demographics
NPI:1134438757
Name:MYERS, WILLIAM ROBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MYERS
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 1:25096 HWY 51
Mailing Address - Street 2:FRED'S PHARMACY # 1489
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059
Mailing Address - Country:US
Mailing Address - Phone:601-892-2227
Mailing Address - Fax:601-892-7798
Practice Address - Street 1:25096 HIGHWAY 51
Practice Address - Street 2:FRED'S PHARMACY # 1489
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059
Practice Address - Country:US
Practice Address - Phone:601-892-2227
Practice Address - Fax:601-892-7798
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist