Provider Demographics
NPI:1750405619
Name:MAGUIRE, WILLIAM CLARK (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLARK
Last Name:MAGUIRE
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 1:635 SUMMER GRASS LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7103
Mailing Address - Country:US
Mailing Address - Phone:770-755-5498
Mailing Address - Fax:
Practice Address - Street 1:11175 CICERO DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1148
Practice Address - Country:US
Practice Address - Phone:770-663-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022936183500000X
MA18527183500000X
NH2328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist