Provider Demographics
NPI:1689969610
Name:WILLIAMS, TRACY M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RHL
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303
Mailing Address - Country:US
Mailing Address - Phone:304-746-0820
Mailing Address - Fax:304-746-0820
Practice Address - Street 1:30 RHL
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8278
Practice Address - Country:US
Practice Address - Phone:304-746-0820
Practice Address - Fax:304-746-0820
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist