Provider Demographics
NPI:1053626853
Name:WILLIAMS, MYRNA LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:LYNN
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 1:4350 GENERAL DEGAULLE DR.
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8643
Mailing Address - Country:US
Mailing Address - Phone:504-391-7755
Mailing Address - Fax:504-391-7753
Practice Address - Street 1:4350 GENERAL DEGAULLE DR.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-8643
Practice Address - Country:US
Practice Address - Phone:504-391-7755
Practice Address - Fax:504-391-7753
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist