Provider Demographics
NPI:1144233461
Name:WILLIAMS-RICHARDSON, MELISSA LEIGH (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEIGH
Last Name:WILLIAMS-RICHARDSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:LEIGH
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:5296 QUAD J RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-8771
Mailing Address - Country:US
Mailing Address - Phone:318-929-9724
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:ATTN: 119
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:318-429-5750
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist