Provider Demographics
NPI:1912336397
Name:HALSTEAD, WILLIAM TYLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TYLER
Last Name:HALSTEAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3418
Mailing Address - Country:US
Mailing Address - Phone:276-386-3821
Mailing Address - Fax:276-386-7582
Practice Address - Street 1:119 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3418
Practice Address - Country:US
Practice Address - Phone:276-863-8213
Practice Address - Fax:276-386-7582
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23962183500000X
VA0202212289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist