Williams LTC Pharmacy, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

60006345A Issued in IN

Legal business name

WILLIAMS LTC PHARMACY, LLC

Practice address

11900 Exit 5 Pkwy
Fishers, IN 46037-7939

Phone

(317) 889-4125

Fax

(317) 889-4134

NPI assigned

Jun 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Clayborne Williams III, RPHNPI 1235557604

Title

Owner/Chief Strategy Officer

Phone

(812) 254-2497

Specialties & licenses 11

Addresses

Other identifiers 2

Other names 1

• Williams LTC Pharmacy, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in IN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Clayborne Williams III, PHARM D.

  • Pharmacist
  • Bloomington, IN
  • NPI 1235557604
  NPD Authorized official
• Amy Pfoff, M.S. CCC-SLP

  • Speech-Language Pathologist
  • Louisville, KY
  • NPI 1093051476
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1770524472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 498",
            "city": "WASHINGTON",
            "state": "IN",
            "postal_code": "475010498",
            "telephone_number": "812-254-2497",
            "fax_number": "812-257-2592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11900 EXIT 5 PKWY",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460377939",
            "telephone_number": "317-889-4125",
            "fax_number": "317-889-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMS LTC PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "CLAYBORNE",
        "authorized_official_title_or_position": "OWNER/CHIEF STRATEGY OFFICER",
        "authorized_official_telephone_number": "812-254-2497",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "60006345A",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203.001778",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "IN",
            "license": "60006345A",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "IL",
            "license": "203.001778",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "IN",
            "license": "60006345A",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "IL",
            "license": "054.018509",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "OH",
            "license": "NRP.022594950-03",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IL",
            "license": "054.018509",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IN",
            "license": "60006345A",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "OH",
            "license": "NRP.022594950-03",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200446060A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2142039",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williams LTC Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Williams LTC Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Macy Wiggington
• Daniel Wikse, MD
• Joel Houston Wilcox, DDS
• Kimberly C. Wilcutts, MPT
• Kaycie Willard
• Allison E Williams, MD
• Ciara Williams
• Derrick A Williams, M.D.
• Elexis Williams
• Halee Williams

• Long Term Care Pharmacy in Fishers, IN
• Providers in Fishers, IN by specialty
• Long Term Care Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.