Healthcare Provider Details

I. General information

NPI: 1902456809
Provider Name (Legal Business Name): DR. KASRAIE WILLIAMSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

6621 MAIN ST APT 2302
MIAMI LAKES FL
33014-2272
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 205-218-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS58419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: