Provider Demographics
NPI:1114211489
Name:WILLIAMS, JOHN ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 42ND AVENUE DR
Mailing Address - Street 2:T0926
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6871
Mailing Address - Country:US
Mailing Address - Phone:309-764-7518
Mailing Address - Fax:309-764-7518
Practice Address - Street 1:900 42ND AVENUE DR
Practice Address - Street 2:TARGET 0926
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6871
Practice Address - Country:US
Practice Address - Phone:309-764-7518
Practice Address - Fax:309-764-7518
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.041158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist