Provider Demographics
NPI:1447576061
Name:WILLIAMSON, LOUISE M (RPH)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:M
Last Name:WILLIAMSON
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:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:FREWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14738-0503
Mailing Address - Country:US
Mailing Address - Phone:716-569-2221
Mailing Address - Fax:
Practice Address - Street 1:26 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREWSBURG
Practice Address - State:NY
Practice Address - Zip Code:14738-9625
Practice Address - Country:US
Practice Address - Phone:716-569-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054215-1183500000X
PARP042586L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist