Healthcare Provider Details

I. General information

NPI: 1639919335
Provider Name (Legal Business Name): STEPHEN EDWIN WILLIAMS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SW 152ND ST
BURIEN WA
98166-1845
US

IV. Provider business mailing address

2221 N TACOMA AVE
TACOMA WA
98403-3016
US

V. Phone/Fax

Practice location:
  • Phone: 253-365-2266
  • Fax:
Mailing address:
  • Phone: 253-365-2266
  • Fax: 360-829-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPH00015256
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: