Provider Demographics
NPI:1174901664
Name:WILLIAMS, WARREN (RPH)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:WILLIAMS
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 1:18525 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:MAUREPAS
Mailing Address - State:LA
Mailing Address - Zip Code:70449-3015
Mailing Address - Country:US
Mailing Address - Phone:225-267-4340
Mailing Address - Fax:225-267-4347
Practice Address - Street 1:18525 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MAUREPAS
Practice Address - State:LA
Practice Address - Zip Code:70449-3015
Practice Address - Country:US
Practice Address - Phone:225-267-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist