Provider Demographics
NPI:1346866472
Name:WILLIAMS, MICHAEL JED (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JED
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E MARKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6245
Mailing Address - Country:US
Mailing Address - Phone:765-868-4798
Mailing Address - Fax:765-868-4923
Practice Address - Street 1:2345 E MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6245
Practice Address - Country:US
Practice Address - Phone:765-868-4798
Practice Address - Fax:765-868-4923
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027786A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist