Provider Demographics
NPI:1861633356
Name:WILLIAMS, ELLEN MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:O'CLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 HEMPHILL PL
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4419
Mailing Address - Country:US
Mailing Address - Phone:518-899-6063
Mailing Address - Fax:518-899-6064
Practice Address - Street 1:3 HEMPHILL PL
Practice Address - Street 2:SUITE 116
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4419
Practice Address - Country:US
Practice Address - Phone:518-899-6063
Practice Address - Fax:518-899-6064
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist