MEDICARE: MR. JEFFERY K WILLIAMS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	25674	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25674	OTHER	TX	TEXAS STATE BOARD OF PHAR

General Provider Information

NPI Number	:	1114081627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFERY K WILLIAMS RPH

Provider Business Mailing Address
First Line	:	9414 OAKLAND LAKE WAY
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6446
Country	:	US
Telephone Number	:	281-772-6960
Fax Number	:	713-667-5030

Provider Business Practice Location Address
First Line	:	9414 OAKLAND LAKE WAY
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6446
Country	:	US
Telephone Number	:	281-772-6960
Fax Number	:	713-667-5030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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