Provider Demographics
NPI:1790008605
Name:WILLIAMS, R LARRY (RPH)
Entity Type:Individual
Prefix:
First Name:R LARRY
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 1:100 E BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:TX
Mailing Address - Zip Code:77486-2726
Mailing Address - Country:US
Mailing Address - Phone:979-345-2147
Mailing Address - Fax:979-345-5173
Practice Address - Street 1:100 E BRAZOS AVE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-2726
Practice Address - Country:US
Practice Address - Phone:979-345-2147
Practice Address - Fax:979-345-5173
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist