Provider Demographics
NPI:1205951878
Name:MCCULLAR, WILLIAM WAYNE (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WAYNE
Last Name:MCCULLAR
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2560
Mailing Address - Country:US
Mailing Address - Phone:318-617-0990
Mailing Address - Fax:
Practice Address - Street 1:3001 E TEXAS ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3207
Practice Address - Country:US
Practice Address - Phone:318-742-6600
Practice Address - Fax:318-742-4207
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist