Provider Demographics
NPI:1043528508
Name:WILLIAMSON, TIMOTHY J (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:WILLIAMSON
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 1:5266 OLD HIGHWAY 11 STE 160
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7820
Mailing Address - Country:US
Mailing Address - Phone:601-261-5922
Mailing Address - Fax:601-261-5939
Practice Address - Street 1:5266 OLD HIGHWAY 11 STE 160
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7820
Practice Address - Country:US
Practice Address - Phone:601-261-5922
Practice Address - Fax:601-261-5939
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist