1114081627 NPI number — MR. JEFFERY K WILLIAMS RPH

Table of content: MR. JEFFERY K WILLIAMS RPH (NPI 1114081627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114081627 NPI number — MR. JEFFERY K WILLIAMS RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
JEFFERY
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
JEFFERY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1114081627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9414 OAKLAND LAKE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOURI CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77459-6446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-772-6960
Provider Business Mailing Address Fax Number:
713-667-5030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9414 OAKLAND LAKE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459-6446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-772-6960
Provider Business Practice Location Address Fax Number:
713-667-5030
Provider Enumeration Date:
12/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  25674 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25674 . This is a "TEXAS STATE BOARD OF PHAR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".