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General NPI Number Information
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NPI Number | 1396182655
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Entity Type | Individual
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Provider Name | DANESHA WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 400 W MOULTRIE DR
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1716
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Country | US
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Telephone | 870-763-7958
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Fax | 870-763-7958
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Provider Business Mailing Address
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Address Line | 54 COUNTY ROAD 2621
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City | SHUBUTA
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State | MS
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Zip | 39360-9056
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Country | US
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Telephone |
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Fax |
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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 | PD12063
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License Number State | AR
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