Provider Demographics
NPI:1295956043
Name:WILLIAMS, ROBERT SCOTT (R PH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:SCOTT
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:90 SUMMIT DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-9736
Mailing Address - Country:US
Mailing Address - Phone:509-840-7770
Mailing Address - Fax:509-882-2603
Practice Address - Street 1:201 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1160
Practice Address - Country:US
Practice Address - Phone:509-882-3151
Practice Address - Fax:509-882-2603
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010451183500000X
WA59731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1223G0001XDental ProvidersDentistGeneral Practice