MEDICARE: DR. VICKI SHAMBLEN 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	1835P1200X	Pharmacotherapy Pharmacist	15189	MD
2	1835P1200X	Pharmacotherapy Pharmacist	RP0006278	WV

General Provider Information

NPI Number	:	1952300931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKI SHAMBLEN WILLIAMS PHARMD

Provider Business Mailing Address
First Line	:	218 AMERICANA LN
Second Line	:
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-7326
Country	:	US
Telephone Number	:	410-212-4365
Fax Number	:	304-754-0069

Provider Business Practice Location Address
First Line	:	71 COWARDLY LION DR
Second Line	:
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6785
Country	:	US
Telephone Number	:	304-754-5800
Fax Number	:

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	01/02/2013

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