Provider Demographics
NPI:1760765622
Name:WILLIAMS, JANE ELLEN (BACHELORS OF SCIENCE)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELLEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BACHELORS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-4500
Mailing Address - Country:US
Mailing Address - Phone:636-271-7944
Mailing Address - Fax:636-239-7941
Practice Address - Street 1:890 WASHINGTON CORS
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4603
Practice Address - Country:US
Practice Address - Phone:636-239-7483
Practice Address - Fax:636-239-7941
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist