Provider Demographics
NPI:1336172964
Name:DOTTEN, WILLIAM BOONE (BS IN PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BOONE
Last Name:DOTTEN
Suffix:
Gender:M
Credentials:BS IN PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11509 OLD NORTON COEBURN RD
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-6511
Mailing Address - Country:US
Mailing Address - Phone:276-395-2163
Mailing Address - Fax:
Practice Address - Street 1:C/O FOOD CITY PHARMACY
Practice Address - Street 2:WISE SHOPPING CENTER
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273
Practice Address - Country:US
Practice Address - Phone:276-679-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202003862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist