Healthcare Provider Details

I. General information

NPI: 1457878993
Provider Name (Legal Business Name): KIERSTEN WILLIAMS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

1617 GRANDVIEW AVE UNIT B
COLUMBUS OH
43212-2457
US

V. Phone/Fax

Practice location:
  • Phone: 724-766-3631
  • Fax:
Mailing address:
  • Phone: 724-766-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRP449525
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: