=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851818249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAMS DRUG COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2017
-----------------------------------------------------
Last Update Date | 04/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8916 BRODIE LANE SUITE 300
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78748-7874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-362-8083
-----------------------------------------------------
Fax | 512-362-8550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12401 ALCANZA DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78739-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-678-4784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | AARON WILLIAMS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 580-678-4784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 31570
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------