Healthcare Provider Details

I. General information

NPI: 1215901905
Provider Name (Legal Business Name): WILLIAMSON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PEARSALL ST
WILLIAMSON NY
14589-9270
US

IV. Provider business mailing address

4102 PEARSALL ST
WILLIAMSON NY
14589-9270
US

V. Phone/Fax

Practice location:
  • Phone: 315-589-3333
  • Fax: 315-589-3335
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number027549
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK HERMENET
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 315-521-0646