Provider Demographics
NPI:1396024790
Name:WILLIAMS, MARK HOWARD (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:HOWARD
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 1:2345 TODD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-5507
Mailing Address - Country:US
Mailing Address - Phone:541-686-0381
Mailing Address - Fax:541-654-0497
Practice Address - Street 1:145 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4107
Practice Address - Country:US
Practice Address - Phone:541-683-9684
Practice Address - Fax:541-485-5413
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6425183500000X
CA31208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist