Provider Demographics
NPI:1942580436
Name:WILLIAMS, LYNNE ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 HAWK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-3706
Mailing Address - Country:US
Mailing Address - Phone:314-429-4636
Mailing Address - Fax:314-429-8664
Practice Address - Street 1:9320 LACKLAND RD
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5458
Practice Address - Country:US
Practice Address - Phone:314-429-4636
Practice Address - Fax:314-429-8664
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist