Provider Demographics
NPI:1790790301
Name:WILLIAMS DRUGS, INC
Entity Type:Organization
Organization Name:WILLIAMS DRUGS, INC
Other - Org Name:WILLIAMS DRUG CO INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICKLEFS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:515-832-1150
Mailing Address - Street 1:611 - 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-1438
Mailing Address - Country:US
Mailing Address - Phone:515-832-1150
Mailing Address - Fax:515-832-1752
Practice Address - Street 1:611 - 2ND ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-1438
Practice Address - Country:US
Practice Address - Phone:515-832-1150
Practice Address - Fax:515-832-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA2253336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA225OtherPHARMACY LICENSE
IA0019513Medicaid
1603782OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0680840001Medicare NSC
IA0019513Medicaid