Healthcare Provider Details

I. General information

NPI: 1871126607
Provider Name (Legal Business Name): WILLIAM WOJTAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30138 PURITAN ST
LIVONIA MI
48154-3271
US

IV. Provider business mailing address

30138 PURITAN ST
LIVONIA MI
48154-3271
US

V. Phone/Fax

Practice location:
  • Phone: 850-305-3227
  • Fax:
Mailing address:
  • Phone: 850-305-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS52103
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302042427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: