Provider Demographics
NPI:1619437688
Name:WILLIAMS, TIMOTHY RAE (BS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W HENDERSON ST STE L20
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2706
Mailing Address - Country:US
Mailing Address - Phone:704-638-2538
Mailing Address - Fax:704-797-8441
Practice Address - Street 1:911 W HENDERSON ST STE L20
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2706
Practice Address - Country:US
Practice Address - Phone:704-638-2538
Practice Address - Fax:704-797-8441
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist