Provider Demographics
NPI:1144524687
Name:WILLIAMS, KAWANDA (PHARMD)
Entity type:Individual
Prefix:
First Name:KAWANDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 JUDY LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-5408
Mailing Address - Country:US
Mailing Address - Phone:318-288-3432
Mailing Address - Fax:
Practice Address - Street 1:3322 JUDY LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-5408
Practice Address - Country:US
Practice Address - Phone:318-288-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-25
Last Update Date:2010-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43923183500000X
LA17842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist