# WILLIAMS LTC PHARMACY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Williams LTC Pharmacy, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770524472
- **Authorized official:** CHARLES CLAYBORNE WILLIAMS III RPH (OWNER/CHIEF STRATEGY OFFICER)
- **Authorized official phone:** (812) 254-2497

## Contact information

- **Practice address:** 11900 EXIT 5 PKWY, FISHERS, IN 46037-7939
- **Practice address phone:** (317) 889-4125
- **Practice address fax:** (317) 889-4134
- **Mailing address:** PO BOX 498, WASHINGTON, IN 47501-0498
- **Mailing address phone:** (812) 254-2497
- **Mailing address fax:** (812) 257-2592

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 203.001778 | IL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 60006345A | IN | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | 203.001778 | IL | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | 60006345A | IN | — |
| 3336H0001X | Home Infusion Therapy Pharmacy | 054.018509 | IL | — |
| 3336H0001X | Home Infusion Therapy Pharmacy | 60006345A | IN | — |
| 3336H0001X | Home Infusion Therapy Pharmacy | NRP.022594950-03 | OH | — |
| 3336L0003X | Long Term Care Pharmacy | 054.018509 | IL | — |
| 3336L0003X | Long Term Care Pharmacy | 60006345A | IN | Yes |
| 3336L0003X | Long Term Care Pharmacy | NRP.022594950-03 | OH | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/10/2006
- **Last updated:** 04/10/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200446060A | — | IN |
| 01 | — | 2142039 | PK | — |