Healthcare Provider Details

I. General information

NPI: 1063532919
Provider Name (Legal Business Name): MARY A WILLIAMS PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MARY A WILLIAMS

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S MAIN ST
DARLINGTON SC
29532-3953
US

IV. Provider business mailing address

315 WYANDOT ST
DARLINGTON SC
29532-4234
US

V. Phone/Fax

Practice location:
  • Phone: 843-395-6020
  • Fax: 843-395-2595
Mailing address:
  • Phone: 843-393-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4138
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: