Provider Demographics
NPI:1407288285
Name:WILLETT, GENNY LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GENNY
Middle Name:LYNN
Last Name:WILLETT
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 1:102 RICHMOND RANCH RD
Mailing Address - Street 2:T-1811
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1081
Mailing Address - Country:US
Mailing Address - Phone:903-223-0062
Mailing Address - Fax:
Practice Address - Street 1:102 RICHMOND RANCH RD
Practice Address - Street 2:T-1811
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1081
Practice Address - Country:US
Practice Address - Phone:903-223-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist