Provider Demographics
NPI:1568740876
Name:WILLIAMS, JEFFREY DONALD (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DONALD
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 244
Mailing Address - Street 2:
Mailing Address - City:WELCHES
Mailing Address - State:OR
Mailing Address - Zip Code:97067-0244
Mailing Address - Country:US
Mailing Address - Phone:503-309-9722
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVE W STE 330
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5600
Practice Address - Country:US
Practice Address - Phone:800-766-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist