Provider Demographics
NPI:1134455678
Name:MANSER, WILLIAM DUWAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DUWAYNE
Last Name:MANSER
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 1:2459 HUGO RD
Mailing Address - Street 2:PO BOX 1496
Mailing Address - City:MERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97532-8780
Mailing Address - Country:US
Mailing Address - Phone:541-476-7335
Mailing Address - Fax:
Practice Address - Street 1:111 UNION AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5579
Practice Address - Country:US
Practice Address - Phone:541-471-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist