Provider Demographics
NPI:1003019126
Name:WILLIAMS, EDWIN KENDALL JR (DPH)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:KENDALL
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 W LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2412
Mailing Address - Country:US
Mailing Address - Phone:901-476-8521
Mailing Address - Fax:901-476-5653
Practice Address - Street 1:100 STAR SHOPPING CTR ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3000
Practice Address - Country:US
Practice Address - Phone:901-476-9444
Practice Address - Fax:901-476-5653
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC3385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist