Provider Demographics
NPI:1356679559
Name:WILLIAMS, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 TRAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3685
Mailing Address - Country:US
Mailing Address - Phone:713-340-0170
Mailing Address - Fax:713-943-2915
Practice Address - Street 1:10997 FUQUA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2409
Practice Address - Country:US
Practice Address - Phone:713-943-9289
Practice Address - Fax:713-943-2915
Is Sole Proprietor?:No
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist