Healthcare Provider Details

I. General information

NPI: 1932626009
Provider Name (Legal Business Name): TRINITY WILLIAMS PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 CABBAGE HAMMOCK RD
SAINT AUGUSTINE FL
32092-0557
US

IV. Provider business mailing address

12496 WINDY WILLOWS DR N
JACKSONVILLE FL
32225-5947
US

V. Phone/Fax

Practice location:
  • Phone: 850-209-3411
  • Fax:
Mailing address:
  • Phone: 850-209-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: