Provider Demographics
NPI:1831787357
Name:WILLIAMS HENSLEY, SAMANTHA DALE (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DALE
Last Name:WILLIAMS HENSLEY
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:PO BOX 1279
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-1279
Mailing Address - Country:US
Mailing Address - Phone:423-346-7800
Mailing Address - Fax:
Practice Address - Street 1:1236 KNOXVILLE HWY
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4200
Practice Address - Country:US
Practice Address - Phone:423-346-7800
Practice Address - Fax:423-346-7875
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist