Provider Demographics
NPI:1912292798
Name:WILLIAMS, SAMUEL JOSEPH (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 SAM FURR RD
Mailing Address - Street 2:T-0966
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8219
Mailing Address - Country:US
Mailing Address - Phone:704-919-6751
Mailing Address - Fax:
Practice Address - Street 1:9801 SAM FURR RD
Practice Address - Street 2:T-0966
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8219
Practice Address - Country:US
Practice Address - Phone:704-919-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist