Provider Demographics
NPI:1801116058
Name:INNERST, WILLIAM G (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:INNERST
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 1:7012 N GLEN HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-9520
Mailing Address - Country:US
Mailing Address - Phone:607-749-2311
Mailing Address - Fax:
Practice Address - Street 1:13 PORT WATSON ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2606
Practice Address - Country:US
Practice Address - Phone:607-753-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024892-1183500000X
PARP041652R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist