MEDICARE: MAURICE WILLIAMS R.PH

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	025269	MO

General Provider Information

NPI Number	:	1710193784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICE WILLIAMS R.PH

Provider Business Mailing Address
First Line	:	13066 MIDFIELD TER
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-6053
Country	:	US
Telephone Number	:	314-434-4711
Fax Number	:

Provider Business Practice Location Address
First Line	:	7010 PERSHING AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-4318
Country	:	US
Telephone Number	:	314-727-4854
Fax Number	:	314-727-1724

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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