Provider Demographics
NPI:1629203138
Name:WILLIAMS, DARRYL GERAND (CPHT)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:GERAND
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8522 N 30TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051
Mailing Address - Country:US
Mailing Address - Phone:623-879-2925
Mailing Address - Fax:
Practice Address - Street 1:8522 N 30TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3904
Practice Address - Country:US
Practice Address - Phone:623-879-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No172A00000XOther Service ProvidersDriver