Provider Demographics
NPI:1316546658
Name:WILLIAMSON, SHAUNITA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAUNITA
Middle Name:MARIE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SPRING CREEK DR APT 108
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-8201
Mailing Address - Country:US
Mailing Address - Phone:919-985-4811
Mailing Address - Fax:
Practice Address - Street 1:4119 BOONSBORO RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2340
Practice Address - Country:US
Practice Address - Phone:434-384-3666
Practice Address - Fax:434-384-6924
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist