Healthcare Provider Details

I. General information

NPI: 1366088486
Provider Name (Legal Business Name): AMIFRED WILLIAMS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2019
Last Update Date: 11/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 WOODMAN DR
DAYTON OH
45431-1423
US

IV. Provider business mailing address

6074 MANSHIRE CT
GALLOWAY OH
43119-8575
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-1901
  • Fax:
Mailing address:
  • Phone: 614-561-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0343950
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: