Provider Demographics
NPI:1477876431
Name:WILLIAMS, EARL GLEN JR (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:GLEN
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19705 HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-9316
Mailing Address - Country:US
Mailing Address - Phone:985-674-7504
Mailing Address - Fax:
Practice Address - Street 1:71041 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7120
Practice Address - Country:US
Practice Address - Phone:985-875-0715
Practice Address - Fax:985-875-9728
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist