Provider Demographics
NPI:1699298760
Name:WILLIAMS, TYREE
Entity type:Individual
Prefix:
First Name:TYREE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 50TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-4572
Mailing Address - Country:US
Mailing Address - Phone:1253-312-3828
Mailing Address - Fax:
Practice Address - Street 1:7512 50TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-4572
Practice Address - Country:US
Practice Address - Phone:125-331-2382
Practice Address - Fax:253-312-3828
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60468409390200000X
WAPH60884534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program