Provider Demographics
NPI:1326345315
Name:WILLIAMS, BRUCE A JR (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:WILLIAMS
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 1:7016 RIDGE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9235
Mailing Address - Country:US
Mailing Address - Phone:336-668-7437
Mailing Address - Fax:
Practice Address - Street 1:7016 RIDGE HAVEN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9235
Practice Address - Country:US
Practice Address - Phone:336-668-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist