=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881009199
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAMS BROS. HEALTH CARE PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2014
-----------------------------------------------------
Last Update Date | 05/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 N GARDENMILE RD STE A
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42420-5543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-869-9197
-----------------------------------------------------
Fax | 270-844-8045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 271
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47501-0271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-254-2497
-----------------------------------------------------
Fax | 812-257-2592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIEF STRATEGY OFFICER
-----------------------------------------------------
Name | CHARLES CLAYBORNE WILLIAMS, III III
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 812-254-2497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------