Provider Demographics
NPI:1255618641
Name:SILVIUS, WILLIAM
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SILVIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 E MAGIC VIEW DR
Mailing Address - Street 2:#190
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3154
Mailing Address - Country:US
Mailing Address - Phone:208-887-1951
Mailing Address - Fax:
Practice Address - Street 1:2950 E MAGIC VIEW DR
Practice Address - Street 2:#190
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3154
Practice Address - Country:US
Practice Address - Phone:208-887-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP43401835G0303X
CA360121835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric