Provider Demographics
NPI:1528191251
Name:WILLIAMS, WAYNE A (RPH)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:A
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 1:2325 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9727
Mailing Address - Country:US
Mailing Address - Phone:419-884-2194
Mailing Address - Fax:
Practice Address - Street 1:86 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-1021
Practice Address - Country:US
Practice Address - Phone:419-886-2561
Practice Address - Fax:419-886-3548
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-14433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist