Provider Demographics
NPI:1023002656
Name:XAVIER WILLIAMS CORPORATION
Entity Type:Organization
Organization Name:XAVIER WILLIAMS CORPORATION
Other - Org Name:CAMERON COUNTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:STRAUB
Authorized Official - Suffix:III
Authorized Official - Credentials:R PH
Authorized Official - Phone:814-781-3192
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-0112
Mailing Address - Country:US
Mailing Address - Phone:814-781-3192
Mailing Address - Fax:814-781-3192
Practice Address - Street 1:318 E 4TH ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1514
Practice Address - Country:US
Practice Address - Phone:814-486-1191
Practice Address - Fax:814-486-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410821L333600000X
PA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012190350003Medicaid
PA3961148OtherNCPDP #
PABM2317546OtherDEA #
PA3961148OtherNCPDP #