Provider Demographics
NPI:1386897478
Name:OWENS, WILLIAM NICHOLSON
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NICHOLSON
Last Name:OWENS
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 1:3132 PEAVINE FIRETOWER ROAD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-0928
Mailing Address - Country:US
Mailing Address - Phone:931-484-1862
Mailing Address - Fax:
Practice Address - Street 1:3132 PEAVINE FIRETOWER RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38571-0928
Practice Address - Country:US
Practice Address - Phone:931-484-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist