MEDICARE: LATODRA WILLIAMS PHARMD, BCSCP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835C0207X	Compounded Sterile Preparations Pharmacist	19002	MD

General Provider Information

NPI Number	:	1033982616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATODRA WILLIAMS PHARMD, BCSCP

Provider Business Mailing Address
First Line	:	3130 CARMEL ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6124
Country	:	US
Telephone Number	:	214-298-9141
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 CARMEL ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6124
Country	:	US
Telephone Number	:	214-298-9141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/06/2023

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