Provider Demographics
NPI:1922306422
Name:WILLIAMSON, JOHN WADE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WADE
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3804
Mailing Address - Country:US
Mailing Address - Phone:919-734-3121
Mailing Address - Fax:
Practice Address - Street 1:806 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3804
Practice Address - Country:US
Practice Address - Phone:919-734-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist