Provider Demographics
NPI:1043035520
Name:WILLIAMS, SHAKARA (CPHT)
Entity type:Individual
Prefix:
First Name:SHAKARA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-3256
Mailing Address - Country:US
Mailing Address - Phone:870-831-6163
Mailing Address - Fax:888-385-2977
Practice Address - Street 1:PO BOX 408
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-0408
Practice Address - Country:US
Practice Address - Phone:870-831-6163
Practice Address - Fax:888-385-2977
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT97749333600000X, 183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No333600000XSuppliersPharmacy