Provider Demographics
NPI:1255623443
Name:WILLIS, LIBBY MCLEMORE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LIBBY
Middle Name:MCLEMORE
Last Name:WILLIS
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 1:690 S REILLY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5626
Mailing Address - Country:US
Mailing Address - Phone:910-826-8942
Mailing Address - Fax:910-826-9069
Practice Address - Street 1:690 S REILLY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-5626
Practice Address - Country:US
Practice Address - Phone:910-826-8942
Practice Address - Fax:910-826-9069
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist