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General NPI Number Information
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NPI Number | 1306881628
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Entity Type | Individual
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Provider Name | RODDY WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1415 HWY 17 BUS NORTH
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City | MYRTLE BEACH
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State | SC
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Zip | 29577
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Country | US
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Telephone | 843-238-5159
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Fax | 843-238-5150
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Provider Business Mailing Address
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Address Line | 1415 HWY 17 BUS NORTH
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City | MYRTLE BEACH
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State | SC
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Zip | 29577
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Country | US
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Telephone | 843-238-5159
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Fax | 843-238-5150
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4579
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License Number State | SC
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