=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861577066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA J. WILLIAMS PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 4TH ST SW
-----------------------------------------------------
City | MASON CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50401-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-422-6847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1707 N 24TH ST
-----------------------------------------------------
City | CLEAR LAKE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50428-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-357-7697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 19484
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------