Provider Demographics
NPI:1083336168
Name:WILLIAMS, EMILY NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 OLD SANDY HOOK RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:MS
Mailing Address - Zip Code:39478-9647
Mailing Address - Country:US
Mailing Address - Phone:601-441-3421
Mailing Address - Fax:
Practice Address - Street 1:1703 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3611
Practice Address - Country:US
Practice Address - Phone:601-684-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024451183500000X
MSE-100780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist