Healthcare Provider Details

I. General information

NPI: 1124028659
Provider Name (Legal Business Name): PATIRICA A WILLMANN MS RPH BCOP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 REYNOLDS ST PHARMACY DEPT
SAVANNAH GA
31405-6015
US

IV. Provider business mailing address

3650 STEVE REYNOLDS BLVD. KAISER PERMANENTE
DULUTH GA
30096
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-8147
  • Fax: 912-819-8468
Mailing address:
  • Phone: 404-365-0966
  • Fax: 912-819-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03213959
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number015077
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: