Provider Demographics
NPI:1700174935
Name:COLVIN, WILLIAM CARROLL (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARROLL
Last Name:COLVIN
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:PO BOX 669
Mailing Address - Street 2:114 SERIO BLVD.
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-0669
Mailing Address - Country:US
Mailing Address - Phone:318-757-4114
Mailing Address - Fax:318-757-4111
Practice Address - Street 1:114 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2013
Practice Address - Country:US
Practice Address - Phone:318-757-4114
Practice Address - Fax:318-757-4111
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist