Provider Demographics
NPI:1063089456
Name:WILLIAMS, DYKEISHA DESHA
Entity type:Individual
Prefix:MISS
First Name:DYKEISHA
Middle Name:DESHA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4223
Mailing Address - Country:US
Mailing Address - Phone:804-225-1340
Mailing Address - Fax:804-225-8072
Practice Address - Street 1:520 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4223
Practice Address - Country:US
Practice Address - Phone:804-225-1340
Practice Address - Fax:804-225-8072
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230021580183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician