Healthcare Provider Details

I. General information

NPI: 1003492760
Provider Name (Legal Business Name): MR. ALTIMAR TAIMAK WILLIAMS I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N MILITARY HWY
NORFOLK VA
23502-2425
US

IV. Provider business mailing address

828 TRAFALGAR CT
VIRGINIA BEACH VA
23462-1028
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-2125
  • Fax: 757-461-6558
Mailing address:
  • Phone: 757-701-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230009640
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: