Provider Demographics
NPI:1730496951
Name:WILLIAMS, KEVIN MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 GAITHER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1725
Mailing Address - Country:US
Mailing Address - Phone:856-380-1828
Mailing Address - Fax:568-291-7009
Practice Address - Street 1:136 GAITHER DR STE 120
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1725
Practice Address - Country:US
Practice Address - Phone:856-380-1828
Practice Address - Fax:568-291-7009
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16134183500000X
ORRPH-00103871835P0018X
NJ28RI02833400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist