Provider Demographics
NPI:1942393483
Name:WILLIAMS, JOHNNIE V (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JOHNNIE
Middle Name:V
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JOHNNIE
Other - Middle Name:
Other - Last Name:VICKERSTAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:509 FOREST PARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:334-821-1909
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL ROAD
Practice Address - Street 2:PHARMACY SERVICE (119)
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist