Provider Demographics
NPI:1295284529
Name:WILLIAMS, AMANDA (RPH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
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 1:6 SHEARER CT
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9382
Mailing Address - Country:US
Mailing Address - Phone:609-451-0277
Mailing Address - Fax:
Practice Address - Street 1:6 SHEARER CT
Practice Address - Street 2:
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088-9382
Practice Address - Country:US
Practice Address - Phone:856-723-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444240183500000X
FLPS40368183500000X
NJ28RI03198300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist