Provider Demographics
NPI:1073835054
Name:WILLIAMS, THERESA M (RPH)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
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 1:4300 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3610
Mailing Address - Country:US
Mailing Address - Phone:919-662-0156
Mailing Address - Fax:919-779-7389
Practice Address - Street 1:4300 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3610
Practice Address - Country:US
Practice Address - Phone:919-662-0156
Practice Address - Fax:919-779-7389
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist