Provider Demographics
NPI:1154927242
Name:WILLIAMS, TIP ALLEN (RPH)
Entity type:Individual
Prefix:
First Name:TIP
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 E SEMMES ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4547
Mailing Address - Country:US
Mailing Address - Phone:601-672-4008
Mailing Address - Fax:662-537-4953
Practice Address - Street 1:2044 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7806
Practice Address - Country:US
Practice Address - Phone:662-332-0177
Practice Address - Fax:662-537-4953
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-07671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty