Healthcare Provider Details

I. General information

NPI: 1669063905
Provider Name (Legal Business Name): JENNIFER WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BLACKWOOD AVE
OCOEE FL
34761-4549
US

IV. Provider business mailing address

1111 BLACKWOOD AVE
OCOEE FL
34761-4549
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-2148
  • Fax:
Mailing address:
  • Phone: 321-842-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: