Healthcare Provider Details

I. General information

NPI: 1851774087
Provider Name (Legal Business Name): KANDECE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 SILVER HILL RD
DISTRICT HEIGHTS MD
20747-1103
US

IV. Provider business mailing address

5870 SILVER HILL RD
DISTRICT HEIGHTS MD
20747-1103
US

V. Phone/Fax

Practice location:
  • Phone: 301-736-3994
  • Fax: 301-967-1344
Mailing address:
  • Phone: 301-736-3994
  • Fax: 301-967-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17281
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: