Healthcare Provider Details

I. General information

NPI: 1124417837
Provider Name (Legal Business Name): MARCUS WADE WILLIAMS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 S JACKSON RD
EDINBURG TX
78539-7228
US

IV. Provider business mailing address

4955 S JACKSON RD
EDINBURG TX
78539-7228
US

V. Phone/Fax

Practice location:
  • Phone: 956-393-2000
  • Fax: 956-393-2010
Mailing address:
  • Phone: 956-393-2000
  • Fax: 956-393-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53878
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15849
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: