Provider Demographics
NPI:1013247436
Name:WILLIAMS, DIBRELL WADE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIBRELL
Middle Name:WADE
Last Name:WILLIAMS
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 1:1540 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4662
Mailing Address - Country:US
Mailing Address - Phone:501-268-5315
Mailing Address - Fax:501-279-7782
Practice Address - Street 1:1540 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4662
Practice Address - Country:US
Practice Address - Phone:501-268-5315
Practice Address - Fax:501-279-7782
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist