Healthcare Provider Details

I. General information

NPI: 1689243859
Provider Name (Legal Business Name): DUSTIN WILLIAMS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 13TH ST STE A
SAINT CLOUD FL
34769-4103
US

IV. Provider business mailing address

18115 TUCKAWAY LN
UMATILLA FL
32784-8611
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-7166
  • Fax:
Mailing address:
  • Phone: 352-455-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS62994
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSI37606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: