Provider Demographics
NPI:1366792731
Name:WILLIAMS, AMANDA L (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7535 GARNERS FERRY RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209
Mailing Address - Country:US
Mailing Address - Phone:803-776-6605
Mailing Address - Fax:803-783-3324
Practice Address - Street 1:7535 GARNERS FERRY RD
Practice Address - Street 2:SUITE G
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209
Practice Address - Country:US
Practice Address - Phone:803-776-6605
Practice Address - Fax:803-783-3324
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist