Provider Demographics
NPI:1760099899
Name:WILLIAMS, TROY LYNN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1210 TOWANDA AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7415
Mailing Address - Country:US
Mailing Address - Phone:309-828-6767
Mailing Address - Fax:309-828-6970
Practice Address - Street 1:1210 TOWANDA AVE STE 11
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7415
Practice Address - Country:US
Practice Address - Phone:309-828-6767
Practice Address - Fax:309-828-6970
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.039891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist