Provider Demographics
NPI:1124476320
Name:WILLIAMS, LATOYA MONIQUE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:MONIQUE
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:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-0335
Mailing Address - Country:US
Mailing Address - Phone:803-625-9001
Mailing Address - Fax:803-625-0577
Practice Address - Street 1:136 MARTIN LUTHER KING JR. BLVD N
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-0335
Practice Address - Country:US
Practice Address - Phone:803-625-9001
Practice Address - Fax:803-625-0577
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36482183500000X
GARPH025359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist