Provider Demographics
NPI:1437127305
Name:WILLIAMS BROS HEALTH CARE PHARMACY INC
Entity Type:Organization
Organization Name:WILLIAMS BROS HEALTH CARE PHARMACY INC
Other - Org Name:WILLIAMS BROS HEALTH CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIEF STRATEGY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CLAYBORNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-254-2497
Mailing Address - Street 1:10 WILLIAMS BROS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-4535
Mailing Address - Country:US
Mailing Address - Phone:812-254-2497
Mailing Address - Fax:812-257-2586
Practice Address - Street 1:101 W BRUMFIELD AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1304
Practice Address - Country:US
Practice Address - Phone:812-386-5194
Practice Address - Fax:812-386-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005293A332B00000X
333600000X, 335E00000X
IL054.0177923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
2028270OtherPK
IN200149490Medicaid
IL=========002Medicaid
2028270OtherPK