Provider Demographics
NPI:1649343989
Name:TOLLE, WILLIAM ALTON (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALTON
Last Name:TOLLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 RIDGELAND RD
Mailing Address - Street 2:
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-8536
Mailing Address - Country:US
Mailing Address - Phone:740-820-5888
Mailing Address - Fax:
Practice Address - Street 1:11826 GALLIA PIKE RD
Practice Address - Street 2:SUITE C
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-9119
Practice Address - Country:US
Practice Address - Phone:740-574-9953
Practice Address - Fax:740-574-1939
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2423050Medicaid