Provider Demographics
NPI:1275925091
Name:WILLIAMSON, JOE BRICE JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:BRICE
Last Name:WILLIAMSON
Suffix:JR
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 1:109 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2259
Mailing Address - Country:US
Mailing Address - Phone:843-394-0298
Mailing Address - Fax:
Practice Address - Street 1:501 E. CHEVES ST.
Practice Address - Street 2:SUITE D
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-777-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC006849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist