Provider Demographics
NPI:1588084693
Name:WILLIAMS, JENNIFER GORE (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GORE
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 1:545 GARDEN CITY CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7847
Mailing Address - Country:US
Mailing Address - Phone:843-357-6588
Mailing Address - Fax:
Practice Address - Street 1:545 GARDEN CITY CONNECTOR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7847
Practice Address - Country:US
Practice Address - Phone:843-357-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist