Provider Demographics
NPI:1083828313
Name:WILLIAMS, JR., JERRY O'NEIL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:O'NEIL
Last Name:WILLIAMS, JR.
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CLARENDON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2955
Mailing Address - Country:US
Mailing Address - Phone:336-288-7497
Mailing Address - Fax:
Practice Address - Street 1:1500 CLARENDON DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2955
Practice Address - Country:US
Practice Address - Phone:336-288-7497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC078571835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy