Healthcare Provider Details

I. General information

NPI: 1215919683
Provider Name (Legal Business Name): SUSAN PATRICIA WILLIAMS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL PKWY
CARSON CITY NV
89703-4625
US

IV. Provider business mailing address

PO BOX 1618
GARDNERVILLE NV
89410-1618
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-8650
  • Fax: 775-445-8655
Mailing address:
  • Phone: 775-229-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16918
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58427
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00061430
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: