Healthcare Provider Details

I. General information

NPI: 1033447727
Provider Name (Legal Business Name): KYMBERLI SHANTA WILLIAMS PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 MATLOCK RD
ARLINGTON TX
76002-4102
US

IV. Provider business mailing address

8100 MATLOCK RD
ARLINGTON TX
76002-4102
US

V. Phone/Fax

Practice location:
  • Phone: 817-473-8674
  • Fax: 817-453-3510
Mailing address:
  • Phone: 817-473-8674
  • Fax: 817-453-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44619
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: