Healthcare Provider Details

I. General information

NPI: 1548369051
Provider Name (Legal Business Name): LYNETTE DAWN WILLIAMS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 S 5TH ST
MONTPELIER ID
83254-1557
US

IV. Provider business mailing address

2918 BORAH RD
AMERICAN FALLS ID
83211-5300
US

V. Phone/Fax

Practice location:
  • Phone: 208-847-1630
  • Fax:
Mailing address:
  • Phone: 208-226-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP4751
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: