Provider Demographics
NPI:1033558994
Name:WILLIAMS, DIANE RUTH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RUTH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15889 CEDARMILL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8717
Mailing Address - Country:US
Mailing Address - Phone:636-537-1911
Mailing Address - Fax:
Practice Address - Street 1:2460 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1222
Practice Address - Country:US
Practice Address - Phone:636-458-7450
Practice Address - Fax:636-530-3002
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist