Healthcare Provider Details

I. General information

NPI: 1942580436
Provider Name (Legal Business Name): LYNNE ANN WILLIAMS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2011
Last Update Date: 08/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 LACKLAND RD
OVERLAND MO
63114-5458
US

IV. Provider business mailing address

3204 HAWK DR
SAINT CHARLES MO
63301-3706
US

V. Phone/Fax

Practice location:
  • Phone: 314-429-4636
  • Fax: 314-429-8664
Mailing address:
  • Phone: 314-429-4636
  • Fax: 314-429-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042476
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: