Provider Demographics
NPI:1356938278
Name:DWYER, WILLIAM CHARLES (R PH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:DWYER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WILLIAM DWYER R PH
Mailing Address - Street 1:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-1382
Mailing Address - Country:US
Mailing Address - Phone:281-433-9356
Mailing Address - Fax:936-588-0605
Practice Address - Street 1:2507 SAND SHORE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1524
Practice Address - Country:US
Practice Address - Phone:281-433-9356
Practice Address - Fax:936-588-0605
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15411183500000X
TX22141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX595699675OtherUSA PASSPORT