Basic Information
| Provider Information | |||||||||
| NPI: | 1114526555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3785 GREENSBORO CT | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551231298 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1752 N FRONTAGE RD | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550333490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514383030 | ||||||||
| FaxNumber: | 6514381100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2020 | ||||||||
| LastUpdateDate: | 10/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 121204 | MN | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 21867 | NC | N | Pharmacy Service Providers | Pharmacist |
No ID Information.