Provider Demographics
NPI:1629396783
Name:JAMIESON, WILLIAM ALFREDO (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALFREDO
Last Name:JAMIESON
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 1:303 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5173
Mailing Address - Country:US
Mailing Address - Phone:845-988-7273
Mailing Address - Fax:
Practice Address - Street 1:542 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3715
Practice Address - Country:US
Practice Address - Phone:718-665-6771
Practice Address - Fax:781-866-5104
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist