MEDICARE: CATHERINE MARY WILLIAMSON B.S. IN PHARMACY

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	26016215A	IN
2	183500000X	Pharmacist	17800	MA

General Provider Information

NPI Number	:	1164408753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE MARY WILLIAMSON B.S. IN PHARMACY

Provider Business Mailing Address
First Line	:	10966 COUNTY ROAD 14
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-9605
Country	:	US
Telephone Number	:	574-825-7043
Fax Number	:	260-768-7832

Provider Business Practice Location Address
First Line	:	CORNER OF MAIN ST. & MORTON ST.
Second Line	:
City	:	SHIPSHEWANA
State	:	IN
Zip	:	46565-0155
Country	:	US
Telephone Number	:	260-768-4882
Fax Number	:	260-768-7832

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/08/2007

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