Provider Demographics
NPI:1790076503
Name:WILLIAMS, OPHELIA MARIE
Entity Type:Individual
Prefix:MS
First Name:OPHELIA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 BRAESRIDGE #1829
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071
Mailing Address - Country:US
Mailing Address - Phone:985-870-5702
Mailing Address - Fax:
Practice Address - Street 1:11100 BRAESRIDGE #1829
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071
Practice Address - Country:US
Practice Address - Phone:985-870-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153528183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician