Provider Demographics
NPI:1811314669
Name:WILLIAMS, GIANNI BAHAM
Entity type:Individual
Prefix:
First Name:GIANNI
Middle Name:BAHAM
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GIANNI
Other - Middle Name:DANIELLE
Other - Last Name:BAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2526 BUSINESS CENTER DR
Mailing Address - Street 2:827
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2295
Mailing Address - Country:US
Mailing Address - Phone:504-912-6439
Mailing Address - Fax:
Practice Address - Street 1:3300 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-5058
Practice Address - Country:US
Practice Address - Phone:281-412-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA046204183500000X
VA0202213289183500000X
TX57580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist