Provider Demographics
NPI:1376970681
Name:WILLIAMS, LORETTA DARLINE (PHARMD)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:DARLINE
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 1:245 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4635
Mailing Address - Country:US
Mailing Address - Phone:501-329-4067
Mailing Address - Fax:501-450-7452
Practice Address - Street 1:245 OAK ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4635
Practice Address - Country:US
Practice Address - Phone:501-329-4067
Practice Address - Fax:501-450-7452
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist