Provider Demographics
NPI:1386040582
Name:WILLIAMS, C. SHANTELLE (RPH)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:SHANTELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-6900
Mailing Address - Country:US
Mailing Address - Phone:985-839-5450
Mailing Address - Fax:985-839-5606
Practice Address - Street 1:731 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-6900
Practice Address - Country:US
Practice Address - Phone:985-839-5450
Practice Address - Fax:985-839-5606
Is Sole Proprietor?:No
Enumeration Date:2014-11-15
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist