Provider Demographics
NPI:1992298442
Name:WILLIAMSON, HERMAINE
Entity type:Individual
Prefix:
First Name:HERMAINE
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 RANGELINE SERVICE RD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9541
Mailing Address - Country:US
Mailing Address - Phone:251-666-7977
Mailing Address - Fax:251-660-7480
Practice Address - Street 1:5245 RANGELINE SERVICE RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9541
Practice Address - Country:US
Practice Address - Phone:251-666-7977
Practice Address - Fax:251-660-7480
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist