Provider Demographics
NPI:1790287886
Name:WILLIAMS, CHARLOTTE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5037
Mailing Address - Country:US
Mailing Address - Phone:319-236-8067
Mailing Address - Fax:319-226-5898
Practice Address - Street 1:2104 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5037
Practice Address - Country:US
Practice Address - Phone:319-236-8067
Practice Address - Fax:319-226-5898
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist