MEDICARE: MR. DARRYL GERAND WILLIAMS CPHT

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	172A00000X	Driver
2	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1629203138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRYL GERAND WILLIAMS CPHT

Provider Business Mailing Address
First Line	:	8522 N 30TH DRIVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051
Country	:	US
Telephone Number	:	623-879-2925
Fax Number	:

Provider Business Practice Location Address
First Line	:	8522 N 30TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-3904
Country	:	US
Telephone Number	:	623-879-2925
Fax Number	:

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

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	07/29/2011

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