Healthcare Provider Details

I. General information

NPI: 1033729918
Provider Name (Legal Business Name): ASHLEY MICHELLE WILLIAMS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 I 55 N
JACKSON MS
39211-5401
US

IV. Provider business mailing address

201 OVERLOOK DR
VICKSBURG MS
39180-6233
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-6554
  • Fax:
Mailing address:
  • Phone: 601-618-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE16620
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: