Provider Demographics
NPI:1104109651
Name:WILLIAMS, DONALD WAYNE JR (PHARM D)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WAYNE
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13068 E COLES CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2189
Mailing Address - Country:US
Mailing Address - Phone:225-294-2481
Mailing Address - Fax:
Practice Address - Street 1:285 W PINE ST
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3310
Practice Address - Country:US
Practice Address - Phone:985-386-6132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA18505OtherPHARMACY LISCENCE