Provider Demographics
NPI:1174611644
Name:WILLIAMS, LORA HICKMAN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:LORA
Middle Name:HICKMAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 BUCKPOINT
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-4337
Mailing Address - Country:US
Mailing Address - Phone:423-357-4496
Mailing Address - Fax:423-345-2181
Practice Address - Street 1:110 BELLAMY AVE.
Practice Address - Street 2:
Practice Address - City:SURGOINSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37873
Practice Address - Country:US
Practice Address - Phone:423-345-3511
Practice Address - Fax:423-345-2181
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9716183500000X
GA017973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist