MEDICARE: AMANDA 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PCT.0011051	CT

General Provider Information

NPI Number	:	1134523434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA WILLIAMS RPH

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVE RM 1004
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1701
Country	:	US
Telephone Number	:	860-714-4761
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 ASYLUM AVE RM 1004
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1701
Country	:	US
Telephone Number	:	860-714-4761
Fax Number	:

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

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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