Provider Demographics
NPI:1528180999
Name:MCWILLIAMS, JEREMIAH SCOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:SCOTT
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 S WALNUT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7413
Mailing Address - Country:US
Mailing Address - Phone:417-886-4206
Mailing Address - Fax:
Practice Address - Street 1:1000 E WALNUT LAWN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7313
Practice Address - Country:US
Practice Address - Phone:417-269-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003000600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist