Provider Demographics
NPI:1417667148
Name:WILLIAMS, SHALENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHALENE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHALENE
Other - Middle Name:
Other - Last Name:FENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22554 COLORADO RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8334
Mailing Address - Country:US
Mailing Address - Phone:209-770-0910
Mailing Address - Fax:
Practice Address - Street 1:1101 SANGUINETTI RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-6214
Practice Address - Country:US
Practice Address - Phone:209-533-2617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist