Provider Demographics
NPI:1285948802
Name:WILLIAMS, SHLONDA FAY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SHLONDA
Middle Name:FAY
Last Name:WILLIAMS
Suffix:
Gender:F
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 1:1934 STATE ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-8310
Mailing Address - Country:US
Mailing Address - Phone:845-292-4114
Mailing Address - Fax:
Practice Address - Street 1:1934 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8310
Practice Address - Country:US
Practice Address - Phone:845-292-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist