Provider Demographics
NPI:1235384553
Name:WILLIAMS, LARRY BLANE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:BLANE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 PECOS ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3061
Mailing Address - Country:US
Mailing Address - Phone:325-949-4636
Mailing Address - Fax:325-942-0761
Practice Address - Street 1:2102 PECOS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3061
Practice Address - Country:US
Practice Address - Phone:325-949-4636
Practice Address - Fax:325-942-0761
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist