Provider Demographics
NPI:1174821599
Name:THE C W WILLIAMS COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:THE C W WILLIAMS COMMUNITY HEALTH CENTER INC
Other - Org Name:C.W. WILLIAMS COMMUNITY HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-393-7720
Mailing Address - Street 1:PO BOX 668093
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-8093
Mailing Address - Country:US
Mailing Address - Phone:704-393-7720
Mailing Address - Fax:704-391-0729
Practice Address - Street 1:900 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5204
Practice Address - Country:US
Practice Address - Phone:704-393-7720
Practice Address - Fax:704-335-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3458557OtherNCPDP PROVIDER IDENTIFICATION NUMBER