Provider Demographics
NPI:1003492760
Name:WILLIAMS, ALTIMAR TAIMAK I
Entity Type:Individual
Prefix:MR
First Name:ALTIMAR
Middle Name:TAIMAK
Last Name:WILLIAMS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 TRAFALGAR CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1028
Mailing Address - Country:US
Mailing Address - Phone:757-701-8796
Mailing Address - Fax:
Practice Address - Street 1:1170 N MILITARY HWY
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2425
Practice Address - Country:US
Practice Address - Phone:757-461-2125
Practice Address - Fax:757-461-6558
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230009640183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician