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General NPI Number Information
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NPI Number | 1215415831
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Entity Type | Organization
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Legal Business Name | JERRY MCWILLIAMS PHARMACY INC.
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 3706 COLLEGE AVE
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City | SNYDER
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State | TX
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Zip | 79549-4625
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Country | US
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Telephone | 325-573-7582
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Fax | 325-573-9023
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Provider Business Mailing Address
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Address Line | 3706 COLLEGE AVE
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City | SNYDER
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State | TX
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Zip | 79549-4625
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Country | US
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Telephone | 325-573-7582
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Fax | 325-573-9023
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Authorized Official
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Title or Position | OWNER
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Name | MIKEL DEE MCWILLIAMS
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Credential | RPH
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Telephone | 325-573-7582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5938
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License Number State | TX
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