Basic Information
| Provider Information | |||||||||
| NPI: | 1942280029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GLENN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 GRAYSON CT | ||||||||
| Address2: | |||||||||
| City: | BEAUFORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285168906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528380116 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NAVAL HOSPITAL CHERRY POINT | ||||||||
| Address2: | BUILDING 4389 | ||||||||
| City: | CHERRY POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285335008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524660254 | ||||||||
| FaxNumber: | 2524660287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 06/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 11064 | NC | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | 11064 | NC | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.