Provider Demographics
NPI:1710193784
Name:WILLIAMS, MAURICE (RPH)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13066 MIDFIELD TER
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-6053
Mailing Address - Country:US
Mailing Address - Phone:314-434-4711
Mailing Address - Fax:
Practice Address - Street 1:7010 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-4318
Practice Address - Country:US
Practice Address - Phone:314-727-4854
Practice Address - Fax:314-727-1724
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO025269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist