Provider Demographics
NPI:1649551052
Name:UPTON, WILLAM TIMOTHY (RPH)
Entity type:Individual
Prefix:
First Name:WILLAM
Middle Name:TIMOTHY
Last Name:UPTON
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 1:5628 CHERYL DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5330
Mailing Address - Country:US
Mailing Address - Phone:608-274-0938
Mailing Address - Fax:
Practice Address - Street 1:4518 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1206
Practice Address - Country:US
Practice Address - Phone:608-222-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9045-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist