=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174567143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAMS BROS. HEALTH CARE PHARMACY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 STATE ST
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47501-8505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-257-2505
-----------------------------------------------------
Fax | 812-257-2506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 WILLIAMS BROS DRIVE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47501-4535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-257-2505
-----------------------------------------------------
Fax | 812-257-2506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIEF STRATEGY OFFICER
-----------------------------------------------------
Name | MR. CHARLES CLAYBORNE WILLIAMS III
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 812-254-2497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number | 60005280A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 60005280A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number | 60005280
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 60005280
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------