Provider Demographics
NPI:1669626628
Name:WILLIAMSON, JERRY THOMAS (PHARM D)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:THOMAS
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S LONG DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4317
Mailing Address - Country:US
Mailing Address - Phone:910-997-4471
Mailing Address - Fax:910-997-4471
Practice Address - Street 1:805 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4317
Practice Address - Country:US
Practice Address - Phone:910-997-4471
Practice Address - Fax:910-997-4471
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist