Provider Demographics
NPI:1487859732
Name:WILLIAMS, DAVID JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:WILLIAMS
Suffix:
Gender:M
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 182
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0182
Mailing Address - Country:US
Mailing Address - Phone:716-592-9065
Mailing Address - Fax:716-592-9064
Practice Address - Street 1:27 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1314
Practice Address - Country:US
Practice Address - Phone:716-592-9065
Practice Address - Fax:716-592-9064
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030176701OtherUNIVERA
NY01973968Medicaid
NY10178460OtherFIDELIS
NY8210881OtherINDEPENDENT HEALTH
NY1281060001Medicare ID - Type Unspecified