Provider Demographics
NPI:1922109974
Name:WILLIAMSON, LEAH K
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:K
Last Name:WILLIAMSON
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 1:9169 HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:BRINKLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72021-9459
Mailing Address - Country:US
Mailing Address - Phone:870-734-4841
Mailing Address - Fax:
Practice Address - Street 1:333 MADISON
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:AR
Practice Address - Zip Code:72029
Practice Address - Country:US
Practice Address - Phone:870-747-3304
Practice Address - Fax:870-747-5324
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1291951Medicaid
AR281107-48-001OtherSTATE SALES TAX