Provider Demographics
NPI:1356559470
Name:MARKHAM, WILLIAM GEORGE (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GEORGE
Last Name:MARKHAM
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 1:360 CIMARRON CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1558
Mailing Address - Country:US
Mailing Address - Phone:928-541-0296
Mailing Address - Fax:
Practice Address - Street 1:1031 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5978
Practice Address - Country:US
Practice Address - Phone:928-636-8425
Practice Address - Fax:928-636-8470
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS10506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist