MEDICARE: JAQUAN M WILLIAMS PHARMD

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	183500000X	Pharmacist	28RI03996400	NJ

General Provider Information

NPI Number	:	1104398775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAQUAN M WILLIAMS PHARMD

Provider Business Mailing Address
First Line	:	292 BRANCH BROOK DR APT A
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-3624
Country	:	US
Telephone Number	:	315-374-1630
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 PASCACK RD
Second Line	:
City	:	TOWNSHIP OF WASHINGTON
State	:	NJ
Zip	:	07676-4809
Country	:	US
Telephone Number	:	201-664-7900
Fax Number	:

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

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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