Healthcare Provider Details

I. General information

NPI: 1770185100
Provider Name (Legal Business Name): PRISCA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W MAIN ST
DALLAS TX
75208-1929
US

IV. Provider business mailing address

6920 MARIGOLD CT
PLANO TX
75074-8922
US

V. Phone/Fax

Practice location:
  • Phone: 123-456-7899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: