Provider Demographics
NPI:1184758922
Name:KORSON, WILLIAM BERNARD (RPH, CDM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BERNARD
Last Name:KORSON
Suffix:
Gender:M
Credentials:RPH, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8682 FARM LN
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9074
Mailing Address - Country:US
Mailing Address - Phone:231-342-8344
Mailing Address - Fax:
Practice Address - Street 1:8605 E 34 RD
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8280
Practice Address - Country:US
Practice Address - Phone:231-876-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist