Provider Demographics
NPI:1891284931
Name:WILLIAMS, DAVID JUSTIN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JUSTIN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 US HIGHWAY 395 N STE 1
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5391
Mailing Address - Country:US
Mailing Address - Phone:775-782-7042
Mailing Address - Fax:775-782-8479
Practice Address - Street 1:2200 HARVARD WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4000
Practice Address - Country:US
Practice Address - Phone:775-689-2211
Practice Address - Fax:775-689-2438
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19637183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist