Provider Demographics
NPI:1639461718
Name:WILLIAMS, AMANDA RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5616
Mailing Address - Country:US
Mailing Address - Phone:757-631-2415
Mailing Address - Fax:757-631-2428
Practice Address - Street 1:3333 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5616
Practice Address - Country:US
Practice Address - Phone:757-631-2415
Practice Address - Fax:757-631-2428
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist