Provider Demographics
NPI:1871970467
Name:WILLIAMS, VICKIE (BS)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7676 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4206
Mailing Address - Country:US
Mailing Address - Phone:562-869-9655
Mailing Address - Fax:562-869-9695
Practice Address - Street 1:7676 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4206
Practice Address - Country:US
Practice Address - Phone:562-869-9655
Practice Address - Fax:562-869-9695
Is Sole Proprietor?:No
Enumeration Date:2015-05-03
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist