Provider Demographics
NPI:1437332186
Name:WILLIAMS, SHELLY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
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 1:311 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:ESPERANCE
Mailing Address - State:NY
Mailing Address - Zip Code:12066-2726
Mailing Address - Country:US
Mailing Address - Phone:518-875-6009
Mailing Address - Fax:
Practice Address - Street 1:673 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-3809
Practice Address - Country:US
Practice Address - Phone:518-234-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist