Healthcare Provider Details

I. General information

NPI: 1891032090
Provider Name (Legal Business Name): BRIAN PAUL WILLIAMS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NE 183RD ST
MIAMI FL
33179-4431
US

IV. Provider business mailing address

100 NE 183RD ST
MIAMI FL
33179-4431
US

V. Phone/Fax

Practice location:
  • Phone: 954-658-6566
  • Fax:
Mailing address:
  • Phone: 954-658-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS35337
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPS35337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: