Provider Demographics
NPI:1427322700
Name:WILLIAMS, MALLORY ANNE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:MALLORY
Other - Middle Name:ANNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1512 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5814
Mailing Address - Country:US
Mailing Address - Phone:870-236-8501
Mailing Address - Fax:870-239-5324
Practice Address - Street 1:1512 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5814
Practice Address - Country:US
Practice Address - Phone:870-236-8501
Practice Address - Fax:870-239-5324
Is Sole Proprietor?:No
Enumeration Date:2012-03-03
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPI20812183700000X
ARPD11966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100212407Medicaid
AR1811983406Medicare NSC