Provider Demographics
NPI:1316547755
Name:WILLIAMS, TENISHA GRACE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:GRACE
Last Name:WILLIAMS
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 1:117 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3163
Mailing Address - Country:US
Mailing Address - Phone:767-637-4868
Mailing Address - Fax:
Practice Address - Street 1:117 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3163
Practice Address - Country:US
Practice Address - Phone:757-637-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist