Provider Demographics
NPI:1285777078
Name:WILLIAMS, JAIME (PHARMD, RPH)
Entity type:Individual
Prefix:MS
First Name:JAIME
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 19TH PL NE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-1404
Mailing Address - Country:US
Mailing Address - Phone:507-455-1321
Mailing Address - Fax:
Practice Address - Street 1:101 22ND ST SE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4415
Practice Address - Country:US
Practice Address - Phone:507-455-9684
Practice Address - Fax:507-455-1750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist