Basic Information
| Provider Information | |||||||||
| NPI: | 1184231961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | FORREST | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 400 30TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106280954 | ||||||||
| FaxNumber: | 8889726505 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 30TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106280954 | ||||||||
| FaxNumber: | 8889726505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2020 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 50391 | CA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 8782 | NC | N | Pharmacy Service Providers | Pharmacist |
No ID Information.