Provider Demographics
NPI:1124417837
Name:WILLIAMS, MARCUS WADE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:WADE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7228
Mailing Address - Country:US
Mailing Address - Phone:956-393-2000
Mailing Address - Fax:956-393-2010
Practice Address - Street 1:4955 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7228
Practice Address - Country:US
Practice Address - Phone:956-393-2000
Practice Address - Fax:956-393-2010
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53878183500000X
AL15849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist