Provider Demographics
NPI:1578051421
Name:WILLIAMSON, CYNTHIA OSBORNE
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:OSBORNE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 THOMASWOOD CHASE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-9542
Mailing Address - Country:US
Mailing Address - Phone:931-455-4913
Mailing Address - Fax:
Practice Address - Street 1:2111 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2207
Practice Address - Country:US
Practice Address - Phone:931-454-0035
Practice Address - Fax:931-454-0035
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4732OtherPHARMACY LICENSE