MEDICARE: BRENDA R. WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	16603	FL

General Provider Information

NPI Number	:	1518958081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA R. WILLIAMS

Provider Business Mailing Address
First Line	:	529 BERKSHIRE CT
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5088
Country	:	US
Telephone Number	:	904-213-9385
Fax Number	:	904-276-1074

Provider Business Practice Location Address
First Line	:	1833 BOULEVARD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-4382
Country	:	US
Telephone Number	:	904-232-2751
Fax Number	:	904-232-1570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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Directions to “ BRENDA R. WILLIAMS ” Practice Location

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