Provider Demographics
NPI:1124411996
Name:WILLIAMS, TANYA KYZER (RPH)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:KYZER
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 1:3720 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5716
Mailing Address - Country:US
Mailing Address - Phone:864-814-2387
Mailing Address - Fax:864-578-4139
Practice Address - Street 1:3720 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5716
Practice Address - Country:US
Practice Address - Phone:864-814-2387
Practice Address - Fax:864-578-4139
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6674183500000X
VA0202211282183500000X
AL16962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist