Provider Demographics
NPI:1457640450
Name:WILLIAMS, LISA DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DIANE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:309 CYRIL DR
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2017
Mailing Address - Country:US
Mailing Address - Phone:512-809-1332
Mailing Address - Fax:
Practice Address - Street 1:527 E BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2915
Practice Address - Country:US
Practice Address - Phone:254-547-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist