Provider Demographics
NPI:1609225200
Name:WILLIAMS FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:WILLIAMS FAMILY PHARMACY LLC
Other - Org Name:WILLIAMS FAMILY PHARMACY, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-839-7200
Mailing Address - Street 1:1058 TANGLEWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-5673
Mailing Address - Country:US
Mailing Address - Phone:985-839-7200
Mailing Address - Fax:985-839-2555
Practice Address - Street 1:1058 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-5673
Practice Address - Country:US
Practice Address - Phone:985-839-7200
Practice Address - Fax:985-839-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007323333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2204530Medicaid
MS03684556Medicaid
2160490OtherPK