Provider Demographics
NPI:1447253398
Name:EAKMAN, MARY WILLIAMS (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:WILLIAMS
Last Name:EAKMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 PECOS ST
Mailing Address - Street 2:STE 13
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3061
Mailing Address - Country:US
Mailing Address - Phone:325-949-5381
Mailing Address - Fax:325-942-9997
Practice Address - Street 1:2102 PECOS ST
Practice Address - Street 2:STE 13
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3061
Practice Address - Country:US
Practice Address - Phone:325-949-5381
Practice Address - Fax:325-942-9997
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21104OtherSTATE BOARD LICENSE NUM