Healthcare Provider Details

I. General information

NPI: 1083715593
Provider Name (Legal Business Name): MISTY A WILLIAMSON PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 HIGHWAY 41 S
GREENBRIER TN
37073-5510
US

IV. Provider business mailing address

159 EAGLE POINTE
SPRINGFIELD TN
37172-6389
US

V. Phone/Fax

Practice location:
  • Phone: 615-643-6979
  • Fax: 615-643-6976
Mailing address:
  • Phone: 615-643-6979
  • Fax: 615-643-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000011286
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: