=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124433545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHALONDA D WILLIAMS PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2014
-----------------------------------------------------
Last Update Date | 07/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 E 64TH ST FL 4
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-7471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-605-3751
-----------------------------------------------------
Fax | 212-434-2287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 E 64TH ST FL 4
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-7471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-605-3751
-----------------------------------------------------
Fax | 212-434-2287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 21218
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 055217
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------