Provider Demographics
NPI:1265623888
Name:MYERS, WILLIAM BRANDON (PHARMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRANDON
Last Name:MYERS
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 1:1548 FORESTDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214
Mailing Address - Country:US
Mailing Address - Phone:205-798-2740
Mailing Address - Fax:205-791-0025
Practice Address - Street 1:1548 FORESTDALE BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214
Practice Address - Country:US
Practice Address - Phone:205-798-2740
Practice Address - Fax:205-791-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002881Medicaid
AL100002881Medicaid