Provider Demographics
NPI:1124344759
Name:DAVIS, WILLIAM CHARLES
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MILBURN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3228
Mailing Address - Country:US
Mailing Address - Phone:516-678-1558
Mailing Address - Fax:516-764-0403
Practice Address - Street 1:124 N LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4415
Practice Address - Country:US
Practice Address - Phone:516-764-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist