MEDICARE: PATRICE S WILLIAMSON PHARM.D

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	17903	NC

General Provider Information

NPI Number	:	1336448224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE S WILLIAMSON PHARM.D

Provider Business Mailing Address
First Line	:	1850 W FRANKLIN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-1468
Country	:	US
Telephone Number	:	704-867-1265
Fax Number	:	704-864-8742

Provider Business Practice Location Address
First Line	:	1850 W FRANKLIN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-1468
Country	:	US
Telephone Number	:	704-867-1265
Fax Number	:	704-864-8742

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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