Provider Demographics
NPI:1700351665
Name:WILLIAMS, BRENDA IRENE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:IRENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 KIPS LN
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-9788
Mailing Address - Country:US
Mailing Address - Phone:803-308-5354
Mailing Address - Fax:
Practice Address - Street 1:4633 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:SC
Practice Address - Zip Code:29112-8180
Practice Address - Country:US
Practice Address - Phone:803-308-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist