Provider Demographics
NPI:1982881140
Name:WILLIAMS, BRENT THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:THOMAS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RUSSELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:NY
Mailing Address - Zip Code:13796-1183
Mailing Address - Country:US
Mailing Address - Phone:607-263-5081
Mailing Address - Fax:
Practice Address - Street 1:5626 STATE HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2050
Practice Address - Country:US
Practice Address - Phone:607-432-9315
Practice Address - Fax:607-432-8027
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01661325Medicaid