Healthcare Provider Details

I. General information

NPI: 1477890275
Provider Name (Legal Business Name): WILLIAM ANDERSON II ROH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 VALENCIA ST
ST AUGUSTINE FL
32084-3541
US

IV. Provider business mailing address

69 VALENCIA ST
ST AUGUSTINE FL
32084-3541
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-5625
  • Fax:
Mailing address:
  • Phone: 904-824-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS18181
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH13138
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: