Provider Demographics
NPI:1538377262
Name:WILLIAMSON, TRICIA LYNN (RPH)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293-1118
Mailing Address - Country:US
Mailing Address - Phone:618-224-7496
Mailing Address - Fax:618-398-5582
Practice Address - Street 1:12 N 64TH ST STE 6
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3809
Practice Address - Country:US
Practice Address - Phone:618-398-5127
Practice Address - Fax:618-398-5582
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0051-286115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist